Organization
14TH AVENUE PHARMACY INC
Active
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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