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General NPI Number Information
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NPI Number | 1700466356
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Entity Type | Organization
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Legal Business Name | NOOKSACK VALLEY DRUG STORE LLC
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Dates
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Enumeration Date | 04/08/2021
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Last Update Date | 06/26/2021
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Provider Practice Location Address
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Address Line | 208 E MAIN ST
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City | EVERSON
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State | WA
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Zip | 98247-9126
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Country | US
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Telephone | 360-966-3481
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Fax | 360-966-3083
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Provider Business Mailing Address
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Address Line | PO BOX 307
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City | EVERSON
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State | WA
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Zip | 98247-0307
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Country | US
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Telephone | 360-966-3481
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Fax | 360-966-3083
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | SCOTT A MITCHELL
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Credential | RPH
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Telephone | 360-303-5451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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