Provider Demographics
NPI:1114903671
Name:MAXOR NATIONAL PHARMACY
Entity Type:Organization
Organization Name:MAXOR NATIONAL PHARMACY
Other - Org Name:PACIFIC MEDICAL PHAMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CERTIFIED PHARMACY TECHNICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-227-3122
Mailing Address - Street 1:12725 SE 167TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-5541
Mailing Address - Country:US
Mailing Address - Phone:425-271-7481
Mailing Address - Fax:
Practice Address - Street 1:601 S CARR RD
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5866
Practice Address - Country:US
Practice Address - Phone:425-227-3122
Practice Address - Fax:425-227-3772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00021561183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Multi-Specialty