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General NPI Number Information
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NPI Number | 1033120530
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Entity Type | Organization
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Legal Business Name | LINCOLN PHARMACY LLC
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 821 S 38TH ST
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City | TACOMA
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State | WA
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Zip | 98418-5028
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Country | US
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Telephone | 253-473-1155
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Fax | 253-473-1158
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Provider Business Mailing Address
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Address Line | 821 S 38TH ST
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City | TACOMA
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State | WA
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Zip | 98418-5028
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Country | US
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Telephone | 253-473-1155
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Fax | 253-473-1158
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Authorized Official
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Title or Position | OWNER
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Name | PATRICK KELLY ODONNELL
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Credential |
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Telephone | 253-473-1155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | CF00058222
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License Number State | WA
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