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General NPI Number Information
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NPI Number | 1972698454
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Entity Type | Organization
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Legal Business Name | MIKE'S EASTSIDE DRUGS
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 8506 E. MILL PLAIN BOULEVARD
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City | VANCOUVER
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State | WA
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Zip | 98664
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Country | US
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Telephone | 360-694-3353
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Fax |
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Provider Business Mailing Address
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Address Line | 8506 E. MILL PLAIN BOULEVARD
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City | VANCOUVER
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State | WA
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Zip | 98664
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Country | US
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Telephone | 360-694-3353
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Fax |
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | MR. MICHAEL GRAEFF
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Credential | R.PH., FACA
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Telephone | 360-694-3353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | CF00001931
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | CF00001931
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | CF00001931
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License Number State | WA
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