Provider Demographics
NPI:1023392784
Name:DUPONT PHARMACY INC
Entity Type:Organization
Organization Name:DUPONT PHARMACY INC
Other - Org Name:DUPONT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, PIC
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PERROU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-888-0955
Mailing Address - Street 1:1545 WILMINGTON DR STE 160
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-9032
Mailing Address - Country:US
Mailing Address - Phone:253-964-3400
Mailing Address - Fax:253-964-3434
Practice Address - Street 1:1545 WILMINGTON DR STE 160
Practice Address - Street 2:
Practice Address - City:DUPONT
Practice Address - State:WA
Practice Address - Zip Code:98327-9032
Practice Address - Country:US
Practice Address - Phone:253-964-3400
Practice Address - Fax:253-964-3434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-29
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X
WAPHAR.CF.602514423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132210OtherPK
WA2015423Medicaid