Provider Demographics
NPI:1285729012
Name:NEILS PHARMACY INC
Entity type:Organization
Organization Name:NEILS PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEGAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-426-3327
Mailing Address - Street 1:512 WEST FRANKLIN
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584
Mailing Address - Country:US
Mailing Address - Phone:360-426-3327
Mailing Address - Fax:360-427-5223
Practice Address - Street 1:512 WEST FRANKLIN
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584
Practice Address - Country:US
Practice Address - Phone:360-426-3327
Practice Address - Fax:360-427-5223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF00001655333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6136006Medicaid
WA028309001Medicare ID - Type Unspecified
WA0283090001Medicare NSC