Organization
LA CONNER DRUG STORE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FREDERICK SANDERS MARTIN RPH (PHARMACIST STORE OWNER)
(360) 466-3124
Entity
Organization
Contact information
Practice address
708 E MORRIS ST, LA CONNER, WA 98257-0477
(360) 466-3124
(360) 466-4775
Mailing address
PO BOX 477, LA CONNER, WA 98257-0477
(360) 466-3124
(360) 466-4775
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
CF00000460
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6043301
—
WA
Enumeration date
09/07/2005
Last updated
08/22/2020
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