MEDICARE: BROWN & COLE STORES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	CF00019389	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366595472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROWN & COLE STORES LLC

Provider Business Mailing Address
First Line	:	1323 COMMERCIAL ST
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-4307
Country	:	US
Telephone Number	:	360-714-7718
Fax Number	:	360-714-7811

Provider Business Practice Location Address
First Line	:	3125 OLD FAIRHAVEN PKWY
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-8266
Country	:	US
Telephone Number	:	360-715-0642
Fax Number	:	360-715-0644

Authorized Official
Title or Position	:	PHARMACY COORDINATOR
Name	:	MR. DAVE RASMUSSON
Credential	:
Telephone Number	:	360-714-7749

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	09/09/2009

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Directions to “BROWN & COLE STORES LLC ” Practice Location

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