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General NPI Number Information
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NPI Number | 1831382324
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Entity Type | Organization
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Legal Business Name | SHOALWATER BAY PHARMACY
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 08/20/2007
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Provider Practice Location Address
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Address Line | 2373 TOKELAND ROAD BUILDING E, SUITE 145
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City | TOKELAND
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State | WA
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Zip | 98590
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Country | US
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Telephone | 360-267-8217
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Fax | 360-267-0568
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Provider Business Mailing Address
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Address Line | 2373 TOKELAND ROAD, BLDG E, STE 145 P.O. BOX 540
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City | TOKELAND
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State | WA
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Zip | 98590
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Country | US
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Telephone | 360-267-8217
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Fax | 360-267-0568
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | STACEY SCHMIDT
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Credential | PHARM.D.
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Telephone | 360-267-8217
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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 | CF00059154
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License Number State | WA
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