Provider Demographics
NPI:1871052696
Name:PHARMACARE SERVICES LLC
Entity type:Organization
Organization Name:PHARMACARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCAULEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:509-236-2422
Mailing Address - Street 1:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:REARDAN
Mailing Address - State:WA
Mailing Address - Zip Code:99029-0636
Mailing Address - Country:US
Mailing Address - Phone:509-413-6577
Mailing Address - Fax:
Practice Address - Street 1:17657 STATE ROUTE 231 N
Practice Address - Street 2:
Practice Address - City:EDWALL
Practice Address - State:WA
Practice Address - Zip Code:99008-9504
Practice Address - Country:US
Practice Address - Phone:509-413-6577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2094798Medicaid