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General NPI Number Information
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NPI Number | 1790504678
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Entity Type | Organization
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Legal Business Name | MENS PHARMACY LLC
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 201 E PIONEER AVE
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City | MONTESANO
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State | WA
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Zip | 98563-4514
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Country | US
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Telephone | 360-249-4831
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Fax | 360-249-4595
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Provider Business Mailing Address
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Address Line | PO BOX B
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City | ILWACO
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State | WA
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Zip | 98624-0167
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JEFFREY HARRELL
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Credential |
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Telephone | 360-244-5984
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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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