Provider Demographics
NPI:1972656098
Name:BROWN & COLE STORES LLC
Entity Type:Organization
Organization Name:BROWN & COLE STORES LLC
Other - Org Name:FOOD PAVILION #775 PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:RASMUSSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-714-7749
Mailing Address - Street 1:1323 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4307
Mailing Address - Country:US
Mailing Address - Phone:360-714-7718
Mailing Address - Fax:360-714-7811
Practice Address - Street 1:149 EASY ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-5995
Practice Address - Country:US
Practice Address - Phone:509-665-0269
Practice Address - Fax:509-665-0752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF000571203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6025555Medicaid
WA6025555Medicaid