Provider Demographics
NPI:1982193223
Name:FRIDAY HARBOR DRUG, LLC
Entity Type:Organization
Organization Name:FRIDAY HARBOR DRUG, LLC
Other - Org Name:FRIDAY HARBOR DRUG & GIFT
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-284-7896
Mailing Address - Street 1:14101 N EASTERN AVE
Mailing Address - Street 2:STE A
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5859
Mailing Address - Country:US
Mailing Address - Phone:405-562-1800
Mailing Address - Fax:
Practice Address - Street 1:210 SPRING ST W
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250-7254
Practice Address - Country:US
Practice Address - Phone:360-378-4421
Practice Address - Fax:360-378-6140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-02
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WAPHAR.CF.608369643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2105235Medicaid