Provider Demographics
NPI:1205371085
Name:SERK APOTHECARY, LLC
Entity Type:Organization
Organization Name:SERK APOTHECARY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SERKALEM
Authorized Official - Middle Name:ASSEFA
Authorized Official - Last Name:AMEDE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:206-313-2950
Mailing Address - Street 1:19410 36TH AVE W STE 3
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5747
Mailing Address - Country:US
Mailing Address - Phone:425-835-0281
Mailing Address - Fax:425-835-0284
Practice Address - Street 1:19410 36TH AVE W STE 3
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5747
Practice Address - Country:US
Practice Address - Phone:425-835-0281
Practice Address - Fax:425-835-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPHAR.CF.607078453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPHR.CF.60707845OtherSTATE LICENSE