Sids Professional Pharmacy
LBN: Professional Mall Pharmacy Inc
Sids Professional Pharmacy is an health care organization with primary practice located at 825 Se Bishop Blvd Ste 301, Pullman WA 99163-5517. The organization recently has 4 registered licenses in different health care specialties including Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy, Suppliers / Compounding Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty.
Professional Mall Pharmacy Inc can be contacted via phone (509) 332-4608, or through Linderman, Darcy via phone (509) 332-0630.
Contact Information
Primary practice address
825 Se Bishop Blvd Ste 301
Pullman WA 99163-5517
Phone: (509) 332-4608
Fax: (509) 332-3341
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Durable Medical Equipment & Medical Supplies | 332B00000X | ||
| Suppliers / Pharmacy | 333600000X | ||
| Suppliers / Community/Retail Pharmacy | 3336C0003X | CF00001254 | Washington |
| Suppliers / Compounding Pharmacy | 3336C0004X |
Profile Details
| NPI number | 1669559530 |
|---|---|
| LBN Legal business name | Professional Mall Pharmacy Inc |
| DBA Doing business as | Sids Professional Pharmacy |
| Authorized official | Linderman, Darcy |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Oct 31st, 2006 |
| Last updated | May 5th, 2015 - about 9 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1669559530 | NPPES |
| Idaho | MEDICAID | 4328400 | |
| Idaho | Other | 4905836 | |
| Idaho | MEDICAID | 6564307 |
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