Provider Demographics
NPI:1326108770
Name:DONG NAI PHARMACY
Entity Type:Organization
Organization Name:DONG NAI PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:THANH
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:CAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-624-4238
Mailing Address - Street 1:620 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2911
Mailing Address - Country:US
Mailing Address - Phone:206-624-4238
Mailing Address - Fax:206-682-2089
Practice Address - Street 1:620 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2911
Practice Address - Country:US
Practice Address - Phone:206-624-4238
Practice Address - Fax:206-682-2089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF00002451333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6051502Medicaid
WA6051502Medicaid