Organization
SOUTH PARK REXALL PHARMACY, INC.
Active
Other names
SOUTH PARK PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH PASKETT RPH (OWNER)
(360) 871-1020
Entity
Organization
Contact information
Practice address
1743 VILLAGE LN SE, PORT ORCHARD, WA 98366-2643
(360) 871-1020
(360) 871-1213
Mailing address
1743 VILLAGE LN SE, PORT ORCHARD, WA 98366-2643
(360) 871-1020
(360) 871-1213
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHARCF00000804
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4911649
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
6174205
—
WA
Enumeration date
09/20/2006
Last updated
05/04/2011
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