Healthcare Provider Details

I. General information

NPI: 1831382324
Provider Name (Legal Business Name): SHOALWATER BAY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2373 TOKELAND ROAD BUILDING E, SUITE 145
TOKELAND WA
98590
US

IV. Provider business mailing address

2373 TOKELAND ROAD, BLDG E, STE 145 P.O. BOX 540
TOKELAND WA
98590
US

V. Phone/Fax

Practice location:
  • Phone: 360-267-8217
  • Fax: 360-267-0568
Mailing address:
  • Phone: 360-267-8217
  • Fax: 360-267-0568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberCF00059154
License Number StateWA

VIII. Authorized Official

Name: STACEY SCHMIDT
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM.D.
Phone: 360-267-8217