Healthcare Provider Details

I. General information

NPI: 1992830137
Provider Name (Legal Business Name): JAMES DOUGLAS BANNISTER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 BAY AVE
OCEAN PARK WA
98640
US

IV. Provider business mailing address

3307 224TH LN
LONG BEACH WA
98631-7302
US

V. Phone/Fax

Practice location:
  • Phone: 360-665-6137
  • Fax: 360-665-6264
Mailing address:
  • Phone: 360-665-2457
  • Fax: 360-665-6264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH019130
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: