Provider Demographics
NPI:1619943693
Name:A & H STORES, INC.
Entity Type:Organization
Organization Name:A & H STORES, INC.
Other - Org Name:FRIDAY HARBOR DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-520-0333
Mailing Address - Street 1:25022 104TH AVE SE
Mailing Address - Street 2:SUITE E
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-2822
Mailing Address - Country:US
Mailing Address - Phone:253-520-0333
Mailing Address - Fax:253-520-0444
Practice Address - Street 1:210 SPRING ST W
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250
Practice Address - Country:US
Practice Address - Phone:360-378-4421
Practice Address - Fax:360-378-6140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF00005414333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA600656507OtherSTATE TAX ID #
4903933OtherNABP
WA6018733Medicaid
0252730009Medicare ID - Type Unspecified