Provider Demographics
NPI:1568526077
Name:THE SISNEY GROUP LLC
Entity Type:Organization
Organization Name:THE SISNEY GROUP LLC
Other - Org Name:DARRINGTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SISNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-436-1200
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:DARRINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98241-0518
Mailing Address - Country:US
Mailing Address - Phone:360-436-1200
Mailing Address - Fax:866-274-1934
Practice Address - Street 1:1200 SEEMAN ST
Practice Address - Street 2:
Practice Address - City:DARRINGTON
Practice Address - State:WA
Practice Address - Zip Code:98241-9103
Practice Address - Country:US
Practice Address - Phone:360-436-1200
Practice Address - Fax:866-274-1934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WAPHAR.CF.604471413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1568526077Medicaid
2145494OtherPK