Healthcare Provider Details

I. General information

NPI: 1235136169
Provider Name (Legal Business Name): CAMP RILEY DRUG CO. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17788 147TH ST SE
MONROE WA
98272-1030
US

IV. Provider business mailing address

17788 147TH ST SE
MONROE WA
98272-1030
US

V. Phone/Fax

Practice location:
  • Phone: 360-794-7351
  • Fax: 360-805-5271
Mailing address:
  • Phone: 360-794-7351
  • Fax: 360-794-5751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number315001080
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. BRIDGETT A EDGAR
Title or Position: MANAGER
Credential: MANAGER
Phone: 360-794-7351