Provider Demographics
NPI:1073659694
Name:MERCURY PHARMACY SVCS INC
Entity type:Organization
Organization Name:MERCURY PHARMACY SVCS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:BOULANGER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:425-673-5200
Mailing Address - Street 1:22316 70TH AVE W STE E5
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2184
Mailing Address - Country:US
Mailing Address - Phone:425-673-5200
Mailing Address - Fax:425-673-5230
Practice Address - Street 1:22316 70TH AVE W STE E
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2184
Practice Address - Country:US
Practice Address - Phone:425-673-5200
Practice Address - Fax:425-673-5230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6024343Medicaid
4925321OtherNCPDP PROVIDER IDENTIFICATION NUMBER
WAPHARCF60832484OtherPHARMACY LICENSE