MEDICARE: GREGORY A HOVANDER

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	183500000X	Pharmacist	PH00009535	WA
2	333600000X	Pharmacy	CF00056612	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	105289	OTHER	WA	STATE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437153467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY A HOVANDER

Provider Business Mailing Address
First Line	:	505 W STEVENS AVE
Second Line	:
City	:	SULTAN
State	:	WA
Zip	:	98294-9453
Country	:	US
Telephone Number	:	360-793-8813
Fax Number	:	360-799-2383

Provider Business Practice Location Address
First Line	:	505 W STEVENS AVE
Second Line	:
City	:	SULTAN
State	:	WA
Zip	:	98294-9453
Country	:	US
Telephone Number	:	360-793-8813
Fax Number	:	360-799-2383

Authorized Official
Title or Position	:	OWNER / PHARMACIST
Name	:	MR. GREGORY ALLAN HOVANDER
Credential	:	RPH
Telephone Number	:	360-793-8813

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	07/01/2008

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Directions to “GREGORY A HOVANDER ” Practice Location

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