Provider Demographics
NPI:1437153467
Name:GREGORY A HOVANDER
Entity Type:Organization
Organization Name:GREGORY A HOVANDER
Other - Org Name:SULTAN PHARMACY & NATURAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:HOVANDER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-793-8813
Mailing Address - Street 1:505 W STEVENS AVE
Mailing Address - Street 2:
Mailing Address - City:SULTAN
Mailing Address - State:WA
Mailing Address - Zip Code:98294-9453
Mailing Address - Country:US
Mailing Address - Phone:360-793-8813
Mailing Address - Fax:360-799-2383
Practice Address - Street 1:505 W STEVENS AVE
Practice Address - Street 2:
Practice Address - City:SULTAN
Practice Address - State:WA
Practice Address - Zip Code:98294-9453
Practice Address - Country:US
Practice Address - Phone:360-793-8813
Practice Address - Fax:360-799-2383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009535183500000X
WACF00056612333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA105289OtherSTATE
WA6023170Medicaid
WA6023170Medicaid