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General NPI Number Information
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NPI Number | 1346465713
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Entity Type | Organization
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Legal Business Name | TOWN AND COUNTRY MARKET INC
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 10/25/2010
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Provider Practice Location Address
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Address Line | 20148 10TH AVE NE
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City | POULSBO
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State | WA
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Zip | 98370-7372
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Country | US
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Telephone | 360-779-5335
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Fax | 360-779-4099
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Provider Business Mailing Address
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Address Line | 20148 10TH AVE NE
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City | POULSBO
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State | WA
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Zip | 98370-7372
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Country | US
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Telephone | 360-779-5335
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Fax | 360-779-4099
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Authorized Official
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Title or Position | PHARMACY MGR
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Name | MR. DAVID KOEHMSTEDT
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Credential | BS
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Telephone | 360-779-5335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | CF00005216
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License Number State | WA
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