| NPI | 1427062256 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH GLEN CAMMACK Owner 360-452-4200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: WA CF00057963) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: WA 9030552) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2015-01-07 |