| Organization Name: | GENEVA WOODS PHARMACY WASHINGTON, LLC |
| NPI Number: | 1033503651 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAN AFRASIABI (PRESIDENT) |
| Mailing Address: | 6135 Martin Way E Suite A Lacey |
| State: | WA US |
| Postal Code: | 985165547 |
| Phone Number: | 3605579509 |
| Fax Number: | 3609159478 |
| NPI Enumeration Date: | 03/20/2015 |
| NPI Last Update Date: | 03/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | 603-447-258 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |