Provider Demographics
NPI:1124787635
Name:PACIFIC CLINICAL SERVICES PLLC
Entity type:Organization
Organization Name:PACIFIC CLINICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST / MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-787-4777
Mailing Address - Street 1:PO BOX 2206
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98674-0021
Mailing Address - Country:US
Mailing Address - Phone:360-787-4777
Mailing Address - Fax:360-857-0500
Practice Address - Street 1:3801 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2258
Practice Address - Country:US
Practice Address - Phone:360-787-4777
Practice Address - Fax:360-857-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-12
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center