Healthcare Provider Details

I. General information

NPI: 1790504678
Provider Name (Legal Business Name): MENS PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E PIONEER AVE
MONTESANO WA
98563-4514
US

IV. Provider business mailing address

PO BOX B
ILWACO WA
98624-0167
US

V. Phone/Fax

Practice location:
  • Phone: 360-249-4831
  • Fax: 360-249-4595
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY HARRELL
Title or Position: MANAGING MEMBER
Credential:
Phone: 360-244-5984