| NPI | 1285822809 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY L WILSON PA-C Provider/Owner 360-748-9320 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: WA PA10000075) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2007-12-20 |