Healthcare Provider Details

I. General information

NPI: 1518444025
Provider Name (Legal Business Name): COLUMBIA PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 NE ANDRESEN RD STE E3
VANCOUVER WA
98661
US

IV. Provider business mailing address

2700 NE ANDRESEN RD STE E3
VANCOUVER WA
98661-7344
US

V. Phone/Fax

Practice location:
  • Phone: 855-900-1515
  • Fax:
Mailing address:
  • Phone: 855-900-1515
  • Fax:

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: RYAN LANG
Title or Position: OWNER
Credential:
Phone: 503-705-4105