Provider Demographics
NPI:1073659637
Name:COST LESS SENIOR SERVICES INC
Entity Type:Organization
Organization Name:COST LESS SENIOR SERVICES INC
Other - Org Name:COSTLESS SENIOR SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER AND MNGR
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-857-7677
Mailing Address - Street 1:PO BOX 823
Mailing Address - Street 2:
Mailing Address - City:WAUNA
Mailing Address - State:WA
Mailing Address - Zip Code:98395-0823
Mailing Address - Country:US
Mailing Address - Phone:253-857-7677
Mailing Address - Fax:253-857-2983
Practice Address - Street 1:14216 92ND AVE NW STE B
Practice Address - Street 2:D
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98329-8710
Practice Address - Country:US
Practice Address - Phone:253-857-7677
Practice Address - Fax:253-857-2983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336I0012X, 3336M0002X
WACF.603347043336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2110915OtherPK
WA6023824Medicaid
WA6023824Medicaid