Provider Demographics
NPI:1689956567
Name:TRI-AREA RX LLC
Entity Type:Organization
Organization Name:TRI-AREA RX LLC
Other - Org Name:TRI-AREA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CIELO
Authorized Official - Middle Name:
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-990-8283
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-0277
Mailing Address - Country:US
Mailing Address - Phone:360-379-9800
Mailing Address - Fax:360-379-8200
Practice Address - Street 1:65 OAK BAY ROAD
Practice Address - Street 2:
Practice Address - City:PORT HADLOCK
Practice Address - State:WA
Practice Address - Zip Code:98339
Practice Address - Country:US
Practice Address - Phone:360-379-9800
Practice Address - Fax:360-379-8200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPHARCF605249633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2150406OtherPK
WAPENDINGMedicaid