Provider Demographics
NPI:1720552656
Name:WASEM'S INC.
Entity Type:Organization
Organization Name:WASEM'S INC.
Other - Org Name:WASEM'S LONG TERM CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WENDT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:509-758-2565
Mailing Address - Street 1:800 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-2093
Mailing Address - Country:US
Mailing Address - Phone:509-758-2565
Mailing Address - Fax:
Practice Address - Street 1:800 6TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2093
Practice Address - Country:US
Practice Address - Phone:509-758-2565
Practice Address - Fax:509-758-2151
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASEM'S
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-14
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003122000Medicaid
WA6083208Medicaid