Organization
14TH AVENUE PHARMACY INC.
Active
Organization
14TH AVENUE PHARMACY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT LOUDERBACK PHARM D (PRESIDENT)
(402) 489-1135
Entity
Organization
Contact information
Practice address
1200 N 14TH AVE, SUITE 100, PASCO, WA 99301-4182
(509) 547-8360
Mailing address
8055 O ST, SUITE 201, LINCOLN, NE 68510-2564
(402) 489-1135
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
CF00057982
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6005128
—
WA
Enumeration date
05/11/2006
Last updated
02/20/2009
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