Healthcare Provider Details

I. General information

NPI: 1265454292
Provider Name (Legal Business Name): SOAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 E MORRIS ST
LA CONNER WA
98257
US

IV. Provider business mailing address

PO BOX 477
LA CONNER WA
98257-0477
US

V. Phone/Fax

Practice location:
  • Phone: 360-466-3124
  • Fax: 360-466-4775
Mailing address:
  • Phone: 360-466-3124
  • Fax: 360-466-4775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberCF0058579
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberCF0058579
License Number StateWA

VIII. Authorized Official

Name: AARON SYRING
Title or Position: OWNER
Credential: PHARMD
Phone: 360-675-6688