Healthcare Provider Details

I. General information

NPI: 1073659637
Provider Name (Legal Business Name): COST LESS SENIOR SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14216 92ND AVE NW STE B D
GIG HARBOR WA
98329-8710
US

IV. Provider business mailing address

PO BOX 823
WAUNA WA
98395-0823
US

V. Phone/Fax

Practice location:
  • Phone: 253-857-7677
  • Fax: 253-857-2983
Mailing address:
  • Phone: 253-857-7677
  • Fax: 253-857-2983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberCF.60334704
License Number StateWA

VIII. Authorized Official

Name: JEFF HENDRICKSON
Title or Position: CO OWNER AND MNGR
Credential:
Phone: 253-857-7677