Healthcare Provider Details

I. General information

NPI: 1255346854
Provider Name (Legal Business Name): QUINCY DRUG CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 F ST SW
QUINCY WA
98848-1213
US

IV. Provider business mailing address

101 F ST SW
QUINCY WA
98848-1213
US

V. Phone/Fax

Practice location:
  • Phone: 509-787-4437
  • Fax: 509-781-5012
Mailing address:
  • Phone: 509-787-4437
  • Fax: 509-781-5012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHAR.CF.00002339
License Number StateWA

VIII. Authorized Official

Name: DAVE MANNING
Title or Position: PRES
Credential:
Phone: 509-781-4431