Organization
LAKETOWN PHARMACY PLLC
Active
Organization
LAKETOWN PHARMACY PLLC
Active
Other names
LAKETOWN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK L DUVALL (GOVERNOR/OWNER)
(509) 765-8891
Entity
Organization
Contact information
Practice address
1550 S PIONEER WAY STE 105, MOSES LAKE, WA 98837-4637
(509) 765-8891
(509) 765-4280
Mailing address
1550 S PIONEER WAY STE 105, MOSES LAKE, WA 98837-4637
(509) 765-8891
(509) 765-4280
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
60642318
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2070654
—
WA
01
—
2160414
PK
—
Enumeration date
03/07/2016
Last updated
03/01/2022
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