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General NPI Number Information
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NPI Number | 1538216619
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Entity Type | Organization
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Legal Business Name | SCHWAB'S COMPOUNDING PHARMACY, INC
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 108 B RAILROAD AVE.
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City | KITTITAS
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State | WA
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Zip | 98934
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Country | US
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Telephone | 509-968-9545
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Fax | 509-962-3013
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Provider Business Mailing Address
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Address Line | PO BOX 757
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City | ELLENSBURG
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State | WA
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Zip | 98926-0757
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Country | US
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Telephone | 509-968-9545
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Fax | 509-962-3013
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Authorized Official
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Title or Position | OWNER
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Name | MR. GRAIG SCHWAB
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Credential | RPH
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Telephone | 509-968-9545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | FO00058330
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License Number State | WA
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