Provider Demographics
NPI:1689819831
Name:GOOD PHARMACY, INC.
Entity Type:Organization
Organization Name:GOOD PHARMACY, INC.
Other - Org Name:GOOD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANG
Authorized Official - Middle Name:
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-584-9164
Mailing Address - Street 1:8511 S TACOMA WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-6521
Mailing Address - Country:US
Mailing Address - Phone:253-584-9164
Mailing Address - Fax:253-588-1722
Practice Address - Street 1:8511 S TACOMA WAY STE 102
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-6521
Practice Address - Country:US
Practice Address - Phone:253-584-9164
Practice Address - Fax:253-588-1722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
WACF600534473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4933114OtherNCPDP PROVIDER IDENTIFICATION NUMBER
WA6032098Medicaid
WA6216100001Medicare NSC