| Organization Name: | FAIRWAY DRUG |
| NPI Number: | 1780760454 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JERRY P KOEHLER (OWNER/PHARMACIST) |
| Mailing Address: | 1758 Front St # 106 Lynden |
| State: | WA US |
| Postal Code: | 982641261 |
| Phone Number: | 3603541226 |
| Fax Number: | 3603546561 |
| NPI Enumeration Date: | 10/27/2006 |
| NPI Last Update Date: | 08/01/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | PHAR.CF.00003781 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |