Provider Demographics
NPI:1033120530
Name:LINCOLN PHARMACY LLC
Entity Type:Organization
Organization Name:LINCOLN PHARMACY LLC
Other - Org Name:LINCOLN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:O DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-473-1155
Mailing Address - Street 1:821 S 38TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-5028
Mailing Address - Country:US
Mailing Address - Phone:253-473-1155
Mailing Address - Fax:253-473-1158
Practice Address - Street 1:821 S 38TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-5028
Practice Address - Country:US
Practice Address - Phone:253-473-1155
Practice Address - Fax:253-473-1158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WACF000582223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2107545OtherPK
WA6027601Medicaid
5457190001Medicare NSC