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Organization

FAIRWAY DRUG, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JERRY P. KOEHLER RPH (MANAGER)
(360) 354-1226
Entity
Organization

Contact information

Practice address
1758 FRONT ST # 106, LYNDEN, WA 98264-1261
(360) 354-1226
(360) 354-6561
Mailing address
1758 FRONT ST # 106, LYNDEN, WA 98264-1261
(360) 354-1226
(360) 354-6561

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
PHAR.CF.00003781
WA
3336C0003X
Community/Retail Pharmacy
Primary
CF00003781
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
6006720
WA
Enumeration date
10/27/2006
Last updated
10/17/2019
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