Organization
SIXTH AVENUE MEDICAL PHARMACY INC
Active
Other names
Sixth Avenue Medical Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ERIK NELSON (PIC)
(509) 455-9345
Entity
Organization
Contact information
Practice address
508 W 6TH AVE, SPOKANE, WA 99204-2770
(509) 455-9345
(509) 455-4479
Mailing address
508 W 6TH AVE, STE 104, SPOKANE, WA 99204-2770
(509) 455-9345
(509) 455-4479
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PHAR.CF.60411553
WA
3336C0003X
Community/Retail Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2143800
PK
—
05
—
6154702
—
WA
Enumeration date
08/10/2006
Last updated
06/21/2016
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