Organization
K-C PHARMACY INC
Active
Organization
K-C PHARMACY INC
Active
Other names
Goldendale Pharmacy, K-C Pharmacy Inc
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY SHANE HARRELL PHARMD (VICE PRESIDENT)
(509) 773-4344
Entity
Organization
Contact information
Practice address
104 W MAIN ST, GOLDENDALE, WA 98620-9589
(509) 773-4344
(509) 773-4555
Mailing address
104 W MAIN ST, GOLDENDALE, WA 98620-9589
(509) 773-4344
(509) 773-4555
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
CF00002121
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4910700
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
611904
—
WA
Enumeration date
10/17/2006
Last updated
02/15/2022
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