Provider Demographics
NPI:1003584509
Name:SAMY'S DRUG STORE INC.
Entity Type:Organization
Organization Name:SAMY'S DRUG STORE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DULLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-878-8174
Mailing Address - Street 1:3525 ENSIGN RD NE STE H
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5065
Mailing Address - Country:US
Mailing Address - Phone:360-878-8174
Mailing Address - Fax:
Practice Address - Street 1:10333 US-12 SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:WA
Practice Address - Zip Code:98579
Practice Address - Country:US
Practice Address - Phone:360-355-9276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAMY'S DRUG STORE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy