Provider Demographics
NPI:1255430112
Name:SEEBERS IDL DRUG INC
Entity type:Organization
Organization Name:SEEBERS IDL DRUG INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEEBER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:509-447-2484
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99156-0609
Mailing Address - Country:US
Mailing Address - Phone:509-447-2484
Mailing Address - Fax:509-447-2485
Practice Address - Street 1:336 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:WA
Practice Address - Zip Code:99156-9671
Practice Address - Country:US
Practice Address - Phone:509-447-2484
Practice Address - Fax:509-447-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WACFOOOO23293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2106963OtherPK
WA6009559Medicaid
ID1255430112Medicaid
0299270001Medicare NSC