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General NPI Number Information
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NPI Number | 1275664377
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Entity Type | Organization
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Legal Business Name | BATTLE GROUND PHARMACY INC
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 09/30/2010
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Provider Practice Location Address
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Address Line | 717 W MAIN ST
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City | BATTLE GROUND
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State | WA
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Zip | 98604-4479
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Country | US
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Telephone | 360-687-3128
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Fax | 360-687-3129
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Provider Business Mailing Address
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Address Line | PO BOX 489
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City | BATTLE GROUND
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State | WA
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Zip | 98604-0489
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | E DARRELL RAFFERTY
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Credential | RPH
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Telephone | 360-687-3128
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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 | CF00001829
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License Number State | WA
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