Provider Demographics
NPI:1932278827
Name:REPUBLIC DRUG STORE
Entity type:Organization
Organization Name:REPUBLIC DRUG STORE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-775-3351
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:WA
Mailing Address - Zip Code:99166-0497
Mailing Address - Country:US
Mailing Address - Phone:509-775-3351
Mailing Address - Fax:509-775-3978
Practice Address - Street 1:6 N CLARK AVE
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:WA
Practice Address - Zip Code:99166-5024
Practice Address - Country:US
Practice Address - Phone:509-775-3351
Practice Address - Fax:509-775-3978
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FERRY COUNTY PUBLIC HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-07
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X, 3336C0003X
WACF000052483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2107010OtherPK
WA6092902Medicaid
0379530001Medicare NSC