Organization
CHENEY OWL PHARMACY INC
Active
Other names
MEDICAL LAKE OWL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA GOYKE PHARMD (OWNER/ PRESIDENT)
(509) 235-8441
Entity
Organization
Contact information
Practice address
123 E LAKE ST, MEDICAL LAKE, WA 99022
(509) 299-5113
(509) 299-9125
Mailing address
PO BOX 638, MEDICAL LAKE, WA 99022-0638
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHARCF00001876
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2107931
PK
—
05
—
6067201
—
WA
Enumeration date
11/03/2006
Last updated
03/11/2024
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