MEDICARE: PARKHILL PHARMACY, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy	5102	WA
3	3336C0004X	Compounding Pharmacy
4	3336L0003X	Long Term Care Pharmacy
5	3336C0003X	Community/Retail Pharmacy

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	G8912458	OTHER	WA	MEDICARE MASS IMMUNIZATION ROSTER BILLING

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	:	1629071493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKHILL PHARMACY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 190
Second Line	:
City	:	LOPEZ ISLAND
State	:	WA
Zip	:	98261-0190
Country	:	US
Telephone Number	:	360-468-2616
Fax Number	:	360-468-3825

Provider Business Practice Location Address
First Line	:	352 LOPEZ ROAD
Second Line	:
City	:	LOPEZ ISLAND
State	:	WA
Zip	:	98261-0190
Country	:	US
Telephone Number	:	360-468-2616
Fax Number	:	360-468-3825

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. RICHARD C MCCOY JR.
Credential	:	R.PH.
Telephone Number	:	360-468-2616

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	04/28/2020

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1780618611 — LOPEZ ISLAND SCHOOL DISTRICT
Practice Location Address:

86 SCHOOL RD
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Practice Location Address:

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1114939329 — MRS. PAULINE LOUISE BARTLE M.D.
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Directions to “PARKHILL PHARMACY, INC. ” Practice Location

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