=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982193223
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRIDAY HARBOR DRUG, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2018
-----------------------------------------------------
Last Update Date | 07/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 210 SPRING ST
-----------------------------------------------------
City | FRIDAY HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98250-7254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-378-4421
-----------------------------------------------------
Fax | 360-378-6140
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14101 N EASTERN AVE STE A
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73013-5859
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-562-1800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | DAVID GEORGE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 580-284-7896
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHAR.CF.60836964
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------