Organization
MARDIX PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AL LOCKWOOD RPH (PRESIDENT)
(253) 630-3833
Entity
Organization
Contact information
Practice address
13308 SE 240TH ST, KENT, WA 98042-5106
(253) 630-3833
(253) 630-0114
Mailing address
13308 SE 240TH ST, KENT, WA 98042-5106
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
CF00001264
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4913643
OTHER ID NUMBER
—
05
—
6048003
—
WA
Enumeration date
12/08/2006
Last updated
09/10/2010
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