Provider Demographics
NPI:1659446235
Name:SARATOGA ENTERPRISES INC
Entity Type:Organization
Organization Name:SARATOGA ENTERPRISES INC
Other - Org Name:LINDS COUPEVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:STALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BSPHARM
Authorized Official - Phone:360-221-0211
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-0070
Mailing Address - Country:US
Mailing Address - Phone:360-678-4010
Mailing Address - Fax:
Practice Address - Street 1:40 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-9556
Practice Address - Country:US
Practice Address - Phone:360-678-4010
Practice Address - Fax:360-678-2075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
WACF000576873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4903173OtherNCPDP PROVIDER IDENTIFICATION NUMBER
WA6030951Medicaid