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General NPI Number Information
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NPI Number | 1063432508
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Entity Type | Organization
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Legal Business Name | CHINOOK PHARMACY INC.
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 11 S FORKS AVE
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City | FORKS
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State | WA
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Zip | 98331-9006
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Country | US
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Telephone | 360-374-2294
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Fax | 360-374-5057
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Provider Business Mailing Address
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Address Line | PO BOX 2136
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City | FORKS
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State | WA
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Zip | 98331-2136
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Country | US
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Telephone | 360-374-2294
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Fax | 360-374-5057
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY SHANE HARRELL
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Credential | PHARMD
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Telephone | 360-244-5984
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | CF00058860
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License Number State | WA
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