Healthcare Provider Details

I. General information

NPI: 1093818130
Provider Name (Legal Business Name): DEMAREST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WESTLAKE AVE
MORTON WA
98356
US

IV. Provider business mailing address

PO BOX 1139
MORTON WA
98356-0020
US

V. Phone/Fax

Practice location:
  • Phone: 360-496-5902
  • Fax: 360-496-3215
Mailing address:
  • Phone: 360-496-5902
  • Fax: 360-496-3215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHAR.CF.00056017
License Number StateWA

VIII. Authorized Official

Name: SANDRA L DEMAREST
Title or Position: PRESIDENT, PIC
Credential:
Phone: 360-496-5902