Provider Demographics
NPI:1922013549
Name:SCHWABS COMPOUNDING PHARMACY
Entity Type:Organization
Organization Name:SCHWABS COMPOUNDING PHARMACY
Other - Org Name:SCHWABS COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-962-3013
Mailing Address - Street 1:PO BOX 757
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-1921
Mailing Address - Country:US
Mailing Address - Phone:509-968-9545
Mailing Address - Fax:509-968-9545
Practice Address - Street 1:108 B RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:KITTITAS
Practice Address - State:WA
Practice Address - Zip Code:98934
Practice Address - Country:US
Practice Address - Phone:509-968-9545
Practice Address - Fax:509-968-9545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPHAR.CF.000583303336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2107661OtherPK
WA6058200Medicaid