=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891853925
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZILLAH DRUG STORE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 607 1ST AVE
-----------------------------------------------------
City | ZILLAH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98953-0565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-829-5691
-----------------------------------------------------
Fax | 509-829-5691
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 565
-----------------------------------------------------
City | ZILLAH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98953-0565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PRES
-----------------------------------------------------
Name | LLOYD SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 509-829-5691
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | CF00005195
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------