Healthcare Provider Details

I. General information

NPI: 1184764177
Provider Name (Legal Business Name): VASHON PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17617 VASHON HWY SW
VASHON WA
98070
US

IV. Provider business mailing address

17617 VASHON HWY SW
VASHON WA
98070
US

V. Phone/Fax

Practice location:
  • Phone: 206-463-9118
  • Fax: 206-463-6950
Mailing address:
  • Phone: 206-463-9118
  • Fax: 206-463-6950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberCF00004132
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: TYLER YOUNG
Title or Position: OWNER
Credential:
Phone: 206-463-9118