Provider Demographics
NPI:1700868064
Name:ONYX PHARMACY, INC.
Entity Type:Organization
Organization Name:ONYX PHARMACY, INC.
Other - Org Name:A-Z PHARMACY & MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:
Authorized Official - Last Name:ORDINARTSEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-852-0159
Mailing Address - Street 1:23643 104TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-3315
Mailing Address - Country:US
Mailing Address - Phone:253-852-0159
Mailing Address - Fax:
Practice Address - Street 1:23643 104TH AVE SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-3315
Practice Address - Country:US
Practice Address - Phone:253-852-0159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF00058237333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5401850002Medicare ID - Type Unspecified