Provider Demographics
NPI:1174681019
Name:CROWN DRUG OF HOQUIAM INC
Entity Type:Organization
Organization Name:CROWN DRUG OF HOQUIAM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRUN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-533-0961
Mailing Address - Street 1:2544 SIMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:HOQUIAM
Mailing Address - State:WA
Mailing Address - Zip Code:98550-3937
Mailing Address - Country:US
Mailing Address - Phone:360-533-0961
Mailing Address - Fax:360-532-8997
Practice Address - Street 1:2544 SIMPSON AVE
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550-3937
Practice Address - Country:US
Practice Address - Phone:360-533-0961
Practice Address - Fax:360-532-8997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF000013733336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6129407Medicaid
WA6129407Medicaid