Provider Demographics
NPI:1194826826
Name:MAXOR NATIONAL PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:MAXOR NATIONAL PHARMACY SERVICES LLC
Other - Org Name:PACIFIC MEDICAL CENTERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-242-7782
Mailing Address - Street 1:320 S POLK ST STE 200
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-1436
Mailing Address - Country:US
Mailing Address - Phone:806-242-7782
Mailing Address - Fax:206-531-2394
Practice Address - Street 1:10416 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7402
Practice Address - Country:US
Practice Address - Phone:206-517-6635
Practice Address - Fax:206-531-2394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WAPHAR.CF.606570933336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2108011OtherPK
WA2076671Medicaid