Provider Demographics
NPI:1073306387
Name:NORTHWEST PHARMACY GROUP LLC
Entity type:Organization
Organization Name:NORTHWEST PHARMACY GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:SRIPRIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHELLAPPAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-388-8257
Mailing Address - Street 1:2703 76TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2735
Mailing Address - Country:US
Mailing Address - Phone:509-388-8257
Mailing Address - Fax:
Practice Address - Street 1:2703 76TH AVE SE
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2735
Practice Address - Country:US
Practice Address - Phone:509-388-8257
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-28
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy