Provider Demographics
NPI:1558669911
Name:CITY CENTER DRUG INC
Entity Type:Organization
Organization Name:CITY CENTER DRUG INC
Other - Org Name:CITY CENTER DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-532-5182
Mailing Address - Street 1:108 E WISHKAH ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-6508
Mailing Address - Country:US
Mailing Address - Phone:360-532-5182
Mailing Address - Fax:360-532-5887
Practice Address - Street 1:108 E WISHKAH ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-6508
Practice Address - Country:US
Practice Address - Phone:360-532-5182
Practice Address - Fax:360-532-5887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPHAR.CF.000592253336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4933950OtherNCPDP PROVIDER IDENTIFICATION NUMBER