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Provider Information for 1285729012


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NEILS PHARMACY INC

Other Names:  
Doing Business As: 
NEILS PHARMACY

Organization Subpart: NO

NPI: 1285729012
Last Updated: 2010-10-05
Certification Date:

Details

NameValue
NPI1285729012
Enumeration Date2006-10-04
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: Mr. ALBERT C LEGAULT
Title: Owner/President
Phone: 3604263327
Mailing Address 512 WEST FRANKLIN
SHELTON, WA 98584
United States

Phone: 360-426-3327 | Fax:360-427-5223
 
Primary Practice Address 512 WEST FRANKLIN
SHELTON, WA 98584
United States

Phone: 360-426-3327 | Fax:360-427-5223
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDWA6136006
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 333600000X - Pharmacy WACF00001655