Provider Demographics
NPI:1821176330
Name:CHENEY OWL PHARMACY INC
Entity Type:Organization
Organization Name:CHENEY OWL PHARMACY INC
Other - Org Name:LIDGERWOOD OWL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOYKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:509-235-8441
Mailing Address - Street 1:220 E ROWAN AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1203
Mailing Address - Country:US
Mailing Address - Phone:509-483-3566
Mailing Address - Fax:509-483-3592
Practice Address - Street 1:5901 N LIDGERWOOD ST
Practice Address - Street 2:STE 100
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1189
Practice Address - Country:US
Practice Address - Phone:509-483-3566
Practice Address - Fax:509-483-3592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WAPHAR.CF.000566603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6023378Medicaid
2110805OtherPK