Organization
EMERALD TITAN HOLDINGS INC
Active
Other names
UP Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CARLO CADIZ (PHARMACIST)
(732) 322-2931
Entity
Organization
Contact information
Practice address
7311 40TH ST W, UNIVERSITY PLACE, WA 98466-4316
(253) 448-2460
(253) 507-8621
Mailing address
7311 40TH ST W, UNIVERSITY PLACE, WA 98466-4316
(253) 448-2460
(253) 507-8621
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHAR.CF.6079962
WA
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2176874
PK
—
Enumeration date
04/03/2018
Last updated
04/19/2018
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