Healthcare Provider Details

I. General information

NPI: 1861409880
Provider Name (Legal Business Name): CHINOOK PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 S FORKS AVE
FORKS WA
98331-9006
US

IV. Provider business mailing address

PO BOX 2136
FORKS WA
98331-2136
US

V. Phone/Fax

Practice location:
  • Phone: 360-374-2294
  • Fax: 360-374-5057
Mailing address:
  • Phone: 360-374-2294
  • Fax: 360-374-5057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberCF00058860
License Number StateWA

VIII. Authorized Official

Name: JEFFREY SHANE HARRELL
Title or Position: OWNER
Credential: PHARMD
Phone: 360-244-5984