Provider Demographics
NPI:1588805634
Name:THE COMPOUNDING APOTHECARY
Entity type:Organization
Organization Name:THE COMPOUNDING APOTHECARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATSUO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:425-672-9888
Mailing Address - Street 1:300 ADMIRAL WAY STE 107
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-7230
Mailing Address - Country:US
Mailing Address - Phone:425-672-9888
Mailing Address - Fax:425-672-8809
Practice Address - Street 1:300 ADMIRAL WAY STE 107
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-7230
Practice Address - Country:US
Practice Address - Phone:425-672-9888
Practice Address - Fax:425-672-8809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60007640183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty