Provider Demographics
NPI:1275294993
Name:CITYSCRIPT PHARMACY LLC
Entity Type:Organization
Organization Name:CITYSCRIPT PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-689-3735
Mailing Address - Street 1:11402 NE 124TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4305
Mailing Address - Country:US
Mailing Address - Phone:425-689-3735
Mailing Address - Fax:425-689-3734
Practice Address - Street 1:11402 NE 124TH ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4305
Practice Address - Country:US
Practice Address - Phone:425-689-3735
Practice Address - Fax:425-242-1741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPHAR.CF.61187727OtherWASHINGTON STATE BOARD OF PHARMACY