Provider Demographics
NPI:1760594675
Name:CHRISELDA GAMINO
Entity Type:Organization
Organization Name:CHRISELDA GAMINO
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-547-7537
Mailing Address - Street 1:1121 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-4158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1121 W COURT ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4158
Practice Address - Country:US
Practice Address - Phone:509-547-7537
Practice Address - Fax:509-546-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF00005096333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6071807Medicaid
4913770OtherOTHER ID NUMBER-COMMERCIAL NUMBER
WABM4356855OtherDEA #
WA1052900001Medicare NSC