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General NPI Number Information
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NPI Number | 1851005003
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Entity Type | Organization
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Legal Business Name | LINCOLN AVE PHARMACY LLC
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Dates
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Enumeration Date | 01/12/2023
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Last Update Date | 01/20/2023
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Provider Practice Location Address
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Address Line | 2810 E LINCOLN AVE STE G
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City | SUNNYSIDE
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State | WA
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Zip | 98944-9799
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Country | US
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Telephone | 509-567-6666
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Fax | 509-213-2817
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Provider Business Mailing Address
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Address Line | 1715 W KENNEWICK AVE
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City | KENNEWICK
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State | WA
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Zip | 99336-3378
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Country | US
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Telephone | 509-567-6666
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Fax | 509-213-2817
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Authorized Official
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Title or Position | CEO
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Name | REDDY ANNAPPAREDDY
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Credential |
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Telephone | 509-841-0000
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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 |
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License Number State |
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