Provider Demographics
NPI:1902981806
Name:OCEAN SHORES PHARMACY PS
Entity Type:Organization
Organization Name:OCEAN SHORES PHARMACY PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-289-4647
Mailing Address - Street 1:PO BOX 1659
Mailing Address - Street 2:
Mailing Address - City:OCEAN SHORES
Mailing Address - State:WA
Mailing Address - Zip Code:98569-1659
Mailing Address - Country:US
Mailing Address - Phone:360-289-4647
Mailing Address - Fax:360-289-3812
Practice Address - Street 1:121 E CHANCE A LA MER NE
Practice Address - Street 2:
Practice Address - City:OCEAN SHORES
Practice Address - State:WA
Practice Address - Zip Code:98569-9419
Practice Address - Country:US
Practice Address - Phone:360-289-4647
Practice Address - Fax:360-289-3812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6140107Medicaid
6051430001Medicare NSC