Provider Demographics
NPI:1689670465
Name:WASEM'S INC.
Entity Type:Organization
Organization Name:WASEM'S INC.
Other - Org Name:WASEM'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WENDT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:509-758-2565
Mailing Address - Street 1:800 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-2013
Mailing Address - Country:US
Mailing Address - Phone:509-758-2565
Mailing Address - Fax:509-758-2151
Practice Address - Street 1:800 6TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2013
Practice Address - Country:US
Practice Address - Phone:509-758-2565
Practice Address - Fax:509-758-2151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA332B00000X
WA022000985332BC3200X
WACF00000917333600000X
3336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003122000Medicaid
WA6083208Medicaid
WA9160086Medicaid
ID003122000Medicaid
WA7330574Medicaid
WA0220110001Medicare ID - Type UnspecifiedCIGNA HEALTHCARE