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General NPI Number Information
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NPI Number | 1346595303
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Entity Type | Organization
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Legal Business Name | PACIFIC NORTHWEST SPECIALTY PHARMACY LLC
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Dates
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Enumeration Date | 07/16/2012
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Last Update Date | 02/22/2021
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Provider Practice Location Address
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Address Line | 3801 MAIN ST STE A
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City | VANCOUVER
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State | WA
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Zip | 98663-2258
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Country | US
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Telephone | 360-448-7890
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Fax | 360-448-7258
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Provider Business Mailing Address
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Address Line | 3801 MAIN ST STE A
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City | VANCOUVER
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State | WA
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Zip | 98663-2258
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Country | US
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Telephone | 360-448-7890
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Fax | 360-448-7258
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | JANET COLEMAN
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Credential |
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Telephone | 360-606-8777
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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 | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | PHARCF60285905
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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