Provider Demographics
NPI:1659511707
Name:SAINT-MARK ENTERPRISES 112 LLC
Entity Type:Organization
Organization Name:SAINT-MARK ENTERPRISES 112 LLC
Other - Org Name:MEDICINE SHOPPE #112
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RIK
Authorized Official - Middle Name:R
Authorized Official - Last Name:ST. GERMAIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:206-650-5541
Mailing Address - Street 1:457 VIA PALERMO DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-0824
Mailing Address - Country:US
Mailing Address - Phone:206-650-5541
Mailing Address - Fax:702-568-8676
Practice Address - Street 1:902 W INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-4508
Practice Address - Country:US
Practice Address - Phone:509-327-1504
Practice Address - Fax:509-327-1505
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT-MARK ENTERPRISES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-03
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6032239Medicaid
WA6233750001Medicare NSC
WA6032239Medicaid