Organization
PENINSULA PHARMACIES INC
Active
Other names
Ilwaco Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TOM SUTHERLAND RPH (PHARMACIST)
(360) 642-3133
Entity
Organization
Contact information
Practice address
101 1ST AVE SOUTH, ILWACO, WA 98624
(360) 642-3133
(360) 642-5133
Mailing address
PO BOX B, ILWACO, WA 98624-0167
(360) 642-3133
(360) 642-5133
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
CF00000398
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50D0957411
WA CLIA
WA
01
—
50D2201997
WA CLIA
WA
05
—
6134001
—
WA
01
—
GAB10691
NORIDIAN / MEDICARE
WA
Enumeration date
10/27/2006
Last updated
07/07/2021
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