Organization
KIRK'S DRUG, INC
Active
Parent organization
KIRK'S DRUG, INC
Other names
Kirk's CHS Medical Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
KIRK'S DRUG, INC
Authorized official
MARVIN JAMES WALETICH RPH (CEO)
(360) 694-7377
Entity
Organization
Contact information
Practice address
6906 MARTIN WAY, OLYMPIA, WA 98516-5567
(360) 456-5475
(360) 491-2161
Mailing address
6149 MARTIN WAY E, LACEY, WA 98516-5547
(360) 493-8614
(360) 493-8612
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
—
WA
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1005114
—
WA
05
—
9011800
—
WA
Enumeration date
05/23/2005
Last updated
08/19/2010
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