Healthcare Provider Details

I. General information

NPI: 1619943693
Provider Name (Legal Business Name): A & H STORES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 SPRING ST W
FRIDAY HARBOR WA
98250
US

IV. Provider business mailing address

25022 104TH AVE SE SUITE E
KENT WA
98030-2822
US

V. Phone/Fax

Practice location:
  • Phone: 360-378-4421
  • Fax: 360-378-6140
Mailing address:
  • Phone: 253-520-0333
  • Fax: 253-520-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberCF00005414
License Number StateWA

VIII. Authorized Official

Name: MR. STACEY J HENDRICKSON
Title or Position: GENERAL COUNSEL
Credential:
Phone: 253-520-0333