LACEY SQUARE PHARMACY INC (NPI# 1750948956) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750948956 |
| Entity Type | Organization |
| Organization Name | LACEY SQUARE PHARMACY INC |
| Practice Address |
6020 Pacific Ave Se Ste C Lacey WA 98503-1319 |
| Mailing Address |
1412 Sw 43rd St Ste 120 Renton WA 98057-4803 |
| Practice Telephone | 4252516335 |
| Practice Fax Number | 4252516337 |
| Mailing Telephone | 4252516335 |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2019-05-22 |
| Authorized Official Name | MR. ANDERSON SHAWN JOLLY (PRESIDENT) |
| Authorized Official Telephone | 4252516335 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | WA PHARMACY LICENSE | PHAR.CF.60953133 | 01 |
| Other Name | Type Code |
|---|---|
| READY MEDS PHARMACY | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | LACEY SQUARE PHARMACY INC. | 6020 Pacific Ave Se, Ste C, Lacey, WA 98503-1319 |
| Street Address |
6020 PACIFIC AVE SE STE C |
| City | LACEY |
| State | WA |
| Zip Code | 98503-1319 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457838989 | Michele Nordgren Bourque | Psychologist | 4329 Concordia Lane Se, Lacey, WA 98503 | 2018-07-26 |
| 1831638675 | Trevor John Marum | Chiropractor | 3945 8th Ave Se, Lacey, WA 98503 | 2017-02-13 |
| 1366993362 | Vanessa Julie Iglesias Mehta | Physician Assistant | 5128 Yelm Hwy Se, Suite E, Lacey, WA 98503 | 2016-10-14 |
| 1144683616 | Millenda Thomas | Registered Nurse | 1233 Firpark Dr. S.e., Lacey, WA 98503 | 2016-04-01 |
| 1609257245 | Erika Charlotte Vonkotzebue | Counselor | 4401 37th Ave. Se #25, Lacey, WA 98503 | 2015-06-09 |
| 1437576196 | Candy Nelson | Registered Nurse | 4410 6th Ave Se, Apt# 115, Lacy, WA 98503 | 2014-03-19 |
| 1134563919 | Alvin Fitzgerald | Pharmacist | 665 Sleater Kinney Rd., S.e, Target Pharmacy #1355, Lacey, WA 98503 | 2013-04-23 |
| 1518200724 | Katherine Mary Marsh | Psychologist | 5191 Corporate Center Court Se, Lacey, WA 98503 | 2013-04-05 |
| 1740530906 | Leanna Marie Mcbroom | Massage Therapist | 1608 Diamond Loop Se, Lacey, WA 98503 | 2012-09-14 |
| 1831445196 | Joyce Emily Christensen Coniff | Counselor | 5706 39th Ave Se., Lacey, WA 98503 | 2012-07-24 |
| Find all providers in zip 98503 | ||||
| Taxonomy Code | 3336L0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Long Term Care Pharmacy |
| A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255433447 | Evergreen Pharmaceutical, LLC | Pharmacy | 1751 Circle Ln Se, Lacey, WA 98503-2570 | 2006-09-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316577869 | Ksr Health Care LLC | Pharmacy | 507 W Stevens Ave Ste Aaa, Sultan, WA 98294-9515 | 2020-01-23 |
| 1730724105 | Silver Lake Pharmacy Inc | Pharmacy | 10315 19th Ave Se Ste 104, Everett, WA 98208-4268 | 2019-11-09 |
| 1437708641 | Ets Consulting LLC | Pharmacy | 6007 244th St Sw Ste A1, Mountlake Terrace, WA 98043-5427 | 2019-09-10 |
| 1891341616 | Nwpa Inc | Pharmacy | 21509 State Route 410 E Ste 4, Bonney Lake, WA 98391-4104 | 2019-08-16 |
| 1669033288 | Suncrest Pharmacy Group, LLC | Pharmacy | 5919f Highway 291, Nine Mile Falls, WA 99026 | 2019-06-25 |
| 1306338868 | Manhattan Village Pharmacy Inc. | Pharmacy | 10102 E Knox Ave Ste 400, Spokane Valley, WA 99206-4146 | 2018-05-31 |
| 1528566981 | Rxltc, Pllc | Pharmacy | 969 Stevens Dr Ste 1b, Richland, WA 99352 | 2018-01-31 |
| 1891167755 | Think Different | Pharmacy | 31710 50th Ln Sw Apt V201, Federal Way, WA 98023-3747 | 2015-10-30 |
| 1104207372 | Prescription Pharmacy Pllc | Pharmacy | 800 Swift Blvd Ste 140, Richland, WA 99352-3559 | 2015-06-14 |
| 1528457728 | Estm Inc | Pharmacy | 133 N Ely St Ste C1, Kennewick, WA 99336-2941 | 2015-01-12 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.