Provider Demographics
NPI:1588675086
Name:HEDDENS PHARMACY INC
Entity Type:Organization
Organization Name:HEDDENS PHARMACY INC
Other - Org Name:HEDDENS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:360-264-2575
Mailing Address - Street 1:PO BOX 4008
Mailing Address - Street 2:
Mailing Address - City:TENINO
Mailing Address - State:WA
Mailing Address - Zip Code:98589-4008
Mailing Address - Country:US
Mailing Address - Phone:360-264-2575
Mailing Address - Fax:360-264-5039
Practice Address - Street 1:196 SUSSEX AVE W
Practice Address - Street 2:
Practice Address - City:TENINO
Practice Address - State:WA
Practice Address - Zip Code:98589-9327
Practice Address - Country:US
Practice Address - Phone:360-264-2575
Practice Address - Fax:360-264-5039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WAPHAR.CF000047863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2107554OtherPK
WA6035208Medicaid
4909769OtherOTHER ID NUMBER-COMMERCIAL NUMBER