Healthcare Provider Details

I. General information

NPI: 1578760260
Provider Name (Legal Business Name): PHARMACA INTEGRATIVE PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 N. 45TH STREET SUITE 110
SEATTLE WA
98103
US

IV. Provider business mailing address

7088 WINCHESTER CIR STE 100
BOULDER CO
80301-3760
US

V. Phone/Fax

Practice location:
  • Phone: 206-547-1208
  • Fax: 206-547-8751
Mailing address:
  • Phone: 303-442-2304
  • Fax: 303-867-4181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberCF59001
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALISON FARRELL
Title or Position: SVP PHARMACY SERVICES
Credential:
Phone: 717-254-9011