Provider Demographics
NPI:1619393535
Name:RX MART PHARMACY LLC
Entity Type:Organization
Organization Name:RX MART PHARMACY LLC
Other - Org Name:RX MART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KAMALPREET
Authorized Official - Middle Name:
Authorized Official - Last Name:DHAMI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:360-933-1401
Mailing Address - Street 1:300 E SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1922
Mailing Address - Country:US
Mailing Address - Phone:360-933-1401
Mailing Address - Fax:360-393-3445
Practice Address - Street 1:300 E SUNSET DR
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1922
Practice Address - Country:US
Practice Address - Phone:360-933-1401
Practice Address - Fax:360-393-3445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-17
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WAPHAR.CF.604353823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2041653Medicaid
2147042OtherPK
WA2041653Medicaid
WA7418180001Medicare NSC
WA7418180001OtherMEDICARE PTAN