Organization
PUBLIC HOSPITAL DIST NO 1 SKAGIT
Active
Other names
Skagit Regional Clinics Mount Vernon Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS LITAKER BS RPH (CHIEF FINANCIAL OFFICER)
(360) 424-2512
Entity
Organization
Contact information
Practice address
1410 E KINCAID ST, MOUNT VERNON, WA 98274-4127
(360) 428-6465
(360) 428-6409
Mailing address
1410 E KINCAID ST, MOUNT VERNON, WA 98274-4127
(360) 428-6465
(360) 428-6409
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHAR.CF.60170291
WA
3336I0012X
Institutional Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2125742
PK
—
05
—
6029326
—
WA
05
—
6029334
—
WA
Enumeration date
06/12/2006
Last updated
02/20/2017
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