Healthcare Provider Details

I. General information

NPI: 1023920105
Provider Name (Legal Business Name): PORT ORCHARD PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1786 SE MILE HILL DR
PORT ORCHARD WA
98366-3512
US

IV. Provider business mailing address

6417 83RD AVE W
UNIVERSITY PLACE WA
98467-3902
US

V. Phone/Fax

Practice location:
  • Phone: 360-443-5144
  • Fax: 360-443-5091
Mailing address:
  • Phone: 425-247-4108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. ANAND GOWDA
Title or Position: PRESIDENT
Credential:
Phone: 425-247-4108