South Park Pharmacy
LBN: South Park Rexall Pharmacy, Inc.
South Park Pharmacy is an health care organization with primary practice located at 1743 Village Ln Se , Port Orchard WA 98366-2643. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty.
South Park Rexall Pharmacy, Inc. can be contacted via phone (360) 871-1020, or through Paskett, Kenneth via phone (360) 871-1020.
Contact Information
Primary practice address
1743 Village Ln Se
Port Orchard WA 98366-2643
Phone: (360) 871-1020
Fax: (360) 871-1213
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Pharmacy | 333600000X | ||
| Suppliers / Community/Retail Pharmacy | 3336C0003X | PHARCF00000804 | Washington |
Profile Details
| NPI number | 1437256278 |
|---|---|
| LBN Legal business name | South Park Rexall Pharmacy, Inc. |
| DBA Doing business as | South Park Pharmacy |
| Authorized official | Paskett, Kenneth RPH |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Sep 20th, 2006 |
| Last updated | May 4th, 2011 - about 13 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 | 1437256278 | NPPES |
| Washington | MEDICAID | 6174205 | |
| Washington | Other | 4911649 |
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