| NPI | 1154451714 |
|---|---|
| Doing Business As | PROVIDENCE APOTHECARY |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Assistant Secretary Enrollment 425-525-5392 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 3336L0003X Pharmacy Long Term Care Pharmacy (Licence: AK 352) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2024-03-04 |