Organization
CENTRALIA PHARMACY GROUP, INC.
Active
Other names
Centralia Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JEFF HARRELL PHARMD (PRESIDENT)
(360) 244-5984
Entity
Organization
Contact information
Practice address
417 S TOWER AVE, CENTRALIA, WA 98531-3917
(360) 736-5000
(360) 736-9433
Mailing address
PO BOX B, ILWACO, WA 98624-0167
(360) 244-5984
(888) 788-5384
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2077225
—
WA
01
—
G8965128
PTAN
WA
Enumeration date
01/19/2017
Last updated
03/31/2022
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