Provider Demographics
NPI:1538216619
Name:SCHWAB'S COMPOUNDING PHARMACY, INC
Entity type:Organization
Organization Name:SCHWAB'S COMPOUNDING PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWAB
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:509-968-9545
Mailing Address - Street 1:PO BOX 757
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-0757
Mailing Address - Country:US
Mailing Address - Phone:509-968-9545
Mailing Address - Fax:509-962-3013
Practice Address - Street 1:108 B RAILROAD AVE.
Practice Address - Street 2:
Practice Address - City:KITTITAS
Practice Address - State:WA
Practice Address - Zip Code:98934
Practice Address - Country:US
Practice Address - Phone:509-968-9545
Practice Address - Fax:509-962-3013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAFO000583303336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA192002748OtherUBI
WA6058200Medicaid
WA0247380001Medicare ID - Type Unspecified