Organization
THE SPECIALTY CARE SHOP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID LINDSLEY (PRESIDENT)
(360) 887-4124
Entity
Organization
Contact information
Practice address
1620 S TAVERNER DR, RIDGEFIELD, WA 98642-7802
(360) 887-4124
Mailing address
PO BOX 1565, RIDGEFIELD, WA 98642-0020
(360) 887-4124
Taxonomy
Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
601756021
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9061821
—
WA
Enumeration date
05/22/2008
Last updated
05/22/2008
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