Provider Demographics
NPI:1760586267
Name:ELK DRUG INC
Entity Type:Organization
Organization Name:ELK DRUG INC
Other - Org Name:ELK DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:THURSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-382-2536
Mailing Address - Street 1:176 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:WA
Mailing Address - Zip Code:99328-1351
Mailing Address - Country:US
Mailing Address - Phone:509-382-2536
Mailing Address - Fax:509-382-2067
Practice Address - Street 1:176 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:WA
Practice Address - Zip Code:99328-1351
Practice Address - Country:US
Practice Address - Phone:509-382-2536
Practice Address - Fax:509-382-2067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
WAPHAR.CF.602142193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2129598OtherPK