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General NPI Number Information
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NPI Number | 1275744294
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Entity Type | Organization
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Legal Business Name | SOUTHWEST WASHINGTON MED CTR OUTPATIENT PHARMACY
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 420 NE MOTHER JOSEPH PLACE
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City | VANCOUVER
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State | WA
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Zip | 98664
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Country | US
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Telephone | 360-514-2349
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Fax | 360-514-1775
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Provider Business Mailing Address
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Address Line | PO BOX 1600
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City | VANCOUVER
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State | WA
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Zip | 98668-1600
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Country | US
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Telephone | 360-514-2349
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Fax | 360-514-1775
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Authorized Official
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Title or Position | OUTPATIENT PHARMACY MANAGER
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Name | REBECCA M CASWELL
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Credential | PHARMACIST
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Telephone | 360-514-2349
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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 | CF00005072
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License Number State | WA
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