Provider Demographics
NPI:1952674541
Name:NORTHWEST PHARMACEUTICAL COMPOUNDING, INC
Entity Type:Organization
Organization Name:NORTHWEST PHARMACEUTICAL COMPOUNDING, INC
Other - Org Name:NORTHWEST PHARMACEUTICAL COMPOUNDING, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-385-2400
Mailing Address - Street 1:15021 MAIN ST
Mailing Address - Street 2:STE'S A & B
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1651
Mailing Address - Country:US
Mailing Address - Phone:425-385-2400
Mailing Address - Fax:425-385-3969
Practice Address - Street 1:15021 MAIN ST
Practice Address - Street 2:STE'S A & B
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1651
Practice Address - Country:US
Practice Address - Phone:425-385-2400
Practice Address - Fax:425-385-3969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPHARCF601296203336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4934368OtherNCPDP PROVIDER IDENTIFICATION NUMBER