Organization
14TH AVENUE PHARMACY INC
Active
Other names
14TH AVENUE COMMUNITY FIRST PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT LOUDERBACK PHARMD (PRESIDENT)
(402) 489-1135
Entity
Organization
Contact information
Practice address
1200 N 14TH AVE, STE 100, PASCO, WA 99301-4182
(509) 547-8360
(509) 547-7571
Mailing address
8055 O ST STE 201, LOUDABACK PHARMACIES, LINCOLN, NE 68510
(402) 489-1135
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
CF00058660
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4931932
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
08/18/2006
Last updated
06/25/2008
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