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General NPI Number Information
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NPI Number | 1629147020
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Entity Type | Organization
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Legal Business Name | MARIKA, INC DBA THE CONNELL PHARMACY
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 140 N COLUMBIA
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City | CONNELL
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State | WA
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Zip | 99326-0070
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Country | US
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Telephone | 509-234-2415
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Fax | 509-234-2414
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Provider Business Mailing Address
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Address Line | PO BOX 70
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City | CONNELL
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State | WA
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Zip | 99326-0070
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Country | US
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Telephone | 509-234-5415
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Fax | 509-234-2414
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Authorized Official
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Title or Position | OWNER PHARMACIST
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Name | MS. MARY MARTHA HALL
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Credential | RPH
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Telephone | 509-234-2415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | CF00057135
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License Number State | WA
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