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General NPI Number Information
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NPI Number | 1124063367
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Entity Type | Organization
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Legal Business Name | VANCOUVER CLINIC INC
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 12/16/2016
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Provider Practice Location Address
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Address Line | 2525 NE 139TH ST SUITE 160
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City | VANCOUVER
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State | WA
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Zip | 98686-2719
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Country | US
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Telephone | 360-397-2880
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Fax | 360-604-1794
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Provider Business Mailing Address
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Address Line | 2525 NE 139TH ST PHARMACY SUITE 160
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City | VANCOUVER
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State | WA
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Zip | 98686-2719
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Country | US
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Telephone | 360-397-2880
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Fax | 360-604-1794
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | LARISSA MORROW
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Credential | PHARMD
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Telephone | 360-397-3880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHARCF00058559
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License Number State | WA
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