Provider Demographics
NPI:1326149501
Name:VENLEE CORPORATION
Entity Type:Organization
Organization Name:VENLEE CORPORATION
Other - Org Name:JACKSON PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACY MANAGE
Authorized Official - Prefix:MR
Authorized Official - First Name:LOC
Authorized Official - Middle Name:BA
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:SR
Authorized Official - Credentials:R PH
Authorized Official - Phone:206-329-0570
Mailing Address - Street 1:1400 S JACKSON ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2059
Mailing Address - Country:US
Mailing Address - Phone:206-329-0570
Mailing Address - Fax:206-328-2413
Practice Address - Street 1:1400 S JACKSON ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2059
Practice Address - Country:US
Practice Address - Phone:206-329-0570
Practice Address - Fax:206-328-2413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPHAR.CF.00004995183500000X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6014286Medicaid
WA6014286Medicaid