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General NPI Number Information
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NPI Number | 1083543458
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Entity Type | Organization
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Legal Business Name | PINE LAKE PHARMACY
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Dates
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Enumeration Date | 05/14/2026
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Last Update Date | 05/14/2026
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Provider Practice Location Address
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Address Line | 3042 ISSAQUAH PINE LAKE RD SE
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City | SAMMAMISH
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State | WA
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Zip | 98075-7253
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Country | US
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Telephone | 425-944-9444
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Fax | 425-944-9449
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Provider Business Mailing Address
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Address Line | 3042 ISSAQUAH PINE LAKE RD SE
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City | SAMMAMISH
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State | WA
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Zip | 98075-7253
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Country | US
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Telephone | 425-944-9444
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Fax | 425-944-9449
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Authorized Official
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Title or Position | OFFICER
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Name | MR. RAMA NARASIMHA RAO MAGANTI
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Credential | RPH
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Telephone | 469-406-6588
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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 |
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License Number State |
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