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General NPI Number Information
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NPI Number | 1346403656
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Entity Type | Organization
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Legal Business Name | LINCOLN CITY PHARMACY & GIFTS
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Dates
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Enumeration Date | 07/07/2008
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Last Update Date | 08/30/2013
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Provider Practice Location Address
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Address Line | 1800 SE HWY 101 SUITE C
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City | LINCOLN CITY
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State | OR
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Zip | 97367
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Country | US
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Telephone | 541-555-1212
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 SE HWY 101 SUITE C
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City | LINCOLN CITY
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State | OR
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Zip | 97367
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Country | US
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Telephone | 541-555-1212
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRIAN MARR
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Credential | RPH
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Telephone | 541-555-1212
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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 | RP0002482CS
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License Number State | OR
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