Provider Demographics
NPI:1093887903
Name:PHARM.D. LLC
Entity Type:Organization
Organization Name:PHARM.D. LLC
Other - Org Name:MEDICINE MART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:V
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:509-674-2571
Mailing Address - Street 1:106 E. 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:CLE ELUM
Mailing Address - State:WA
Mailing Address - Zip Code:98922
Mailing Address - Country:US
Mailing Address - Phone:509-966-9672
Mailing Address - Fax:509-972-8324
Practice Address - Street 1:3910 SUMMITVIEW AVE STE 140
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2780
Practice Address - Country:US
Practice Address - Phone:509-966-9672
Practice Address - Fax:509-972-8324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6025589Medicaid