Organization
NYBERG HEALTH ENTERPRISES INC
Active
Other names
SNOQUALMIE VILLAGE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
BROCKMAN/SHANNA NYBERG BS PHARM (PRES AND VP)
(425) 221-0129
Entity
Organization
Contact information
Practice address
7730 CENTER BLVD SE, SNOQUALMIE, WA 98065-8743
(425) 396-7474
(425) 396-7454
Mailing address
PO BOX 797, SNOQUALMIE, WA 98065-0797
(425) 396-7474
(425) 396-7454
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHARCF00058496
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4931716
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
6028922
—
WA
Enumeration date
07/30/2006
Last updated
02/07/2013
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