Provider Demographics
NPI:1629324520
Name:QUALITY FOOD CENTERS
Entity type:Organization
Organization Name:QUALITY FOOD CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:B
Authorized Official - Last Name:IREDALE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-683-1156
Mailing Address - Street 1:990 E WASHINGTON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3517
Mailing Address - Country:US
Mailing Address - Phone:360-683-1156
Mailing Address - Fax:360-683-8532
Practice Address - Street 1:990 E WASHINGTON ST
Practice Address - Street 2:SUITE B
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3517
Practice Address - Country:US
Practice Address - Phone:360-683-1156
Practice Address - Fax:360-683-8532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-28
Last Update Date:2012-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00022371183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6013890Medicaid