Provider Demographics
NPI:1053678649
Name:MAXOR NATIONAL PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:MAXOR NATIONAL PHARMACY SERVICES LLC
Other - Org Name:PACIFIC MEDICAL CENTERS PHARMACY-TOTEM LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-242-7782
Mailing Address - Street 1:320 S POLK ST STE 200
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-1436
Mailing Address - Country:US
Mailing Address - Phone:806-242-7782
Mailing Address - Fax:206-531-2394
Practice Address - Street 1:12910 TOTEM LAKE BLVD NE STE 101
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2901
Practice Address - Country:US
Practice Address - Phone:425-814-5003
Practice Address - Fax:206-531-2394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPHAR.CF.606570783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2134809OtherPK