Organization
KSR HEALTH CARE LLC
Active
Other names
Invara
Organization subpart
No
Provider details
NPI number
Authorized official
SIMEON ROTH PHARMD (PHARMACY MANAGER)
(360) 953-5250
Entity
Organization
Contact information
Practice address
31111 US-2, SULTAN, WA 98294
(360) 953-5250
(360) 294-8529
Mailing address
PO BOX 90, SULTAN, WA 98294-0090
(360) 953-5250
(360) 294-8529
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2132773
—
WA
Enumeration date
03/15/2019
Last updated
03/10/2022
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