| NPI | 1386789584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID GLENN BLACKSTOCK President 425-487-2744 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: WA 601983357) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2020-08-22 |