Provider Demographics
NPI:1346465713
Name:TOWN AND COUNTRY MARKET INC
Entity Type:Organization
Organization Name:TOWN AND COUNTRY MARKET INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KOEHMSTEDT
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:360-779-5335
Mailing Address - Street 1:20148 10TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7372
Mailing Address - Country:US
Mailing Address - Phone:360-779-5335
Mailing Address - Fax:360-779-4099
Practice Address - Street 1:20148 10TH AVE NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7372
Practice Address - Country:US
Practice Address - Phone:360-779-5335
Practice Address - Fax:360-779-4099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF00005216183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0668730001Medicare NSC