Provider Demographics
NPI:1073659694
Name:MERCURY PHARMACY SVCS INC
Entity Type:Organization
Organization Name:MERCURY PHARMACY SVCS INC
Other - Org Name:MERCURY PHARMACY SVCS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOULANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-673-5200
Mailing Address - Street 1:PO BOX 3196
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98046-3196
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22316 70TH AVE W STE 5
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2184
Practice Address - Country:US
Practice Address - Phone:425-673-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAFL000569233336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4925321OtherNCPDP PROVIDER IDENTIFICATION NUMBER
WA6024343Medicaid
4925321OtherNCPDP PROVIDER IDENTIFICATION NUMBER