Provider Demographics
NPI:1548205776
Name:CAMMACKS PHARMACIES INC
Entity Type:Organization
Organization Name:CAMMACKS PHARMACIES INC
Other - Org Name:JIMS PHARMACY AND HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMMACK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-452-4200
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0035
Mailing Address - Country:US
Mailing Address - Phone:360-452-4200
Mailing Address - Fax:360-457-6557
Practice Address - Street 1:424 E 2ND ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3119
Practice Address - Country:US
Practice Address - Phone:360-452-4200
Practice Address - Fax:360-457-6557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336S0011X
WAPHARCF000579633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2108181OtherPK
WA6148704Medicaid
WA6148704Medicaid