Healthcare Provider Details

I. General information

NPI: 1043571235
Provider Name (Legal Business Name): QFC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 06/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 E NORTH BEND WAY
NORTH BEND WA
98045-8270
US

IV. Provider business mailing address

460 E NORTH BEND WAY PO BOX 329
NORTH BEND WA
98045-8270
US

V. Phone/Fax

Practice location:
  • Phone: 425-888-2357
  • Fax: 425-831-1953
Mailing address:
  • Phone: 425-888-2357
  • Fax: 425-831-1953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH00009475
License Number StateWA

VIII. Authorized Official

Name: JOHN MARSHALL
Title or Position: PHARMACY MANAGER
Credential: RPH
Phone: 425-888-2357