Provider Demographics
NPI:1568538619
Name:STA-RAW EAST, INC.
Entity Type:Organization
Organization Name:STA-RAW EAST, INC.
Other - Org Name:MEDICAL ARTS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHOATE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-423-7847
Mailing Address - Street 1:901 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2322
Mailing Address - Country:US
Mailing Address - Phone:360-423-7847
Mailing Address - Fax:360-414-4112
Practice Address - Street 1:901 15TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2322
Practice Address - Country:US
Practice Address - Phone:360-423-7847
Practice Address - Fax:360-414-4112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6019285Medicaid
WA6019285Medicaid