Provider Demographics
NPI:1629147020
Name:MARIKA, INC DBA THE CONNELL PHARMACY
Entity Type:Organization
Organization Name:MARIKA, INC DBA THE CONNELL PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:MARTHA
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:509-234-2415
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:CONNELL
Mailing Address - State:WA
Mailing Address - Zip Code:99326-0070
Mailing Address - Country:US
Mailing Address - Phone:509-234-5415
Mailing Address - Fax:509-234-2414
Practice Address - Street 1:140 N COLUMBIA
Practice Address - Street 2:
Practice Address - City:CONNELL
Practice Address - State:WA
Practice Address - Zip Code:99326-0070
Practice Address - Country:US
Practice Address - Phone:509-234-2415
Practice Address - Fax:509-234-2414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF000571353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0157483OtherWA STATE LABOR AND INDUST
WA6025381Medicaid
WA6025381Medicaid