Healthcare Provider Details

I. General information

NPI: 1114237633
Provider Name (Legal Business Name): CASCADE SPECIALTY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19062 STATE HIGHWAY 305 NE
POULSBO WA
98370-7336
US

IV. Provider business mailing address

19062 STATE HIGHWAY 305 NE
POULSBO WA
98370-7336
US

V. Phone/Fax

Practice location:
  • Phone: 360-779-2737
  • Fax: 360-779-4905
Mailing address:
  • Phone: 360-779-2737
  • Fax: 360-779-4905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SAVANNAH MANSOUR
Title or Position: M&A LICENSING MANAGER
Credential:
Phone: 224-715-2685