Healthcare Provider Details

I. General information

NPI: 1952302382
Provider Name (Legal Business Name): SOAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 03/07/2023
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32170 STATE ROUTE 20
OAK HARBOR WA
98277-3774
US

IV. Provider business mailing address

32170 STATE ROUTE 20
OAK HARBOR WA
98277-3719
US

V. Phone/Fax

Practice location:
  • Phone: 360-675-6688
  • Fax: 360-675-1563
Mailing address:
  • Phone: 360-675-6688
  • Fax: 360-675-1563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberCF60341892
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHAR.CF.60341892
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPHAR.CF.60341892
License Number StateWA
# 7
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHAR.CF.60341892
License Number StateWA

VIII. Authorized Official

Name: MR. AARON MATTHEW SYRING
Title or Position: OWNER
Credential: PHARM.D.
Phone: 360-675-6688