=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821584350
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POA PHARMA NORTH AMERICA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2018
-----------------------------------------------------
Last Update Date | 07/09/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4400 NE 77TH AVE SUITE 275
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98662-6857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-416-6826
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4400 NE 77TH AVE STE 275
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98662-6857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-416-6826
-----------------------------------------------------
Fax | 360-326-1621
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. TINA MADSEN SANDSTROM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 855-416-6826
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------