=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427062256
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAMMACKS PHARMACIES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2006
-----------------------------------------------------
Last Update Date | 01/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 424 E 2ND ST
-----------------------------------------------------
City | PORT ANGELES
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98362-3119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-452-4200
-----------------------------------------------------
Fax | 360-457-6557
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 424 E 2ND ST
-----------------------------------------------------
City | PORT ANGELES
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98362-3119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-452-4200
-----------------------------------------------------
Fax | 360-457-6557
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. JOSEPH GLEN CAMMACK
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 360-452-4200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 9030552
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | CF00057963
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------