Organization
PEACEHEALTH
Active
Other names
PeaceHealth St John Medical Center Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CHARMAINE MODE (MGR PHARMACY SJM - PHARMACY)
(360) 414-7656
Entity
Organization
Contact information
Practice address
1615 DELAWARE ST, LONGVIEW, WA 98632-2367
(360) 414-7451
(360) 636-4921
Mailing address
PO BOX 3002, LONGVIEW, WA 98632-0302
(360) 414-7656
(360) 636-4921
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHAR.CF.00056869
WA
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2022930
—
WA
01
—
2135946
PK
—
Enumeration date
07/09/2012
Last updated
02/16/2022
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