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General NPI Number Information
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NPI Number | 1609117944
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Entity Type | Organization
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Legal Business Name | PHARMADREAM INC
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Dates
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Enumeration Date | 03/12/2013
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Last Update Date | 03/12/2013
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Provider Practice Location Address
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Address Line | 207 N 3RD ST STE 2
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City | GARFIELD
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State | WA
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Zip | 99130
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Country | US
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Telephone | 509-648-3430
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Fax | 509-648-3217
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Provider Business Mailing Address
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Address Line | PO BOX 277
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City | SAINT JOHN
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State | WA
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Zip | 99171-0277
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Country | US
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Telephone | 509-648-3430
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Fax | 509-648-3217
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Authorized Official
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Title or Position | PHARMACIST
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Name | MICHELLE WELCH
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Credential |
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Telephone | 509-648-3430
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 60341889
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License Number State | WA
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