Provider Demographics
NPI:1982759023
Name:TWIN HARBOR DRUG, INC.
Entity Type:Organization
Organization Name:TWIN HARBOR DRUG, INC.
Other - Org Name:TWIN HARBOR DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARGERY ROXANE
Authorized Official - Middle Name:GALE DELA CRUZ
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-953-0344
Mailing Address - Street 1:PO BOX 385
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:WA
Mailing Address - Zip Code:98595-0385
Mailing Address - Country:US
Mailing Address - Phone:360-268-0505
Mailing Address - Fax:360-268-1302
Practice Address - Street 1:733 N. MONTESANO STREET
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:WA
Practice Address - Zip Code:98595-0385
Practice Address - Country:US
Practice Address - Phone:360-268-0116
Practice Address - Fax:360-268-1302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000075543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1046476Medicaid
WA6079800Medicaid