| NPI | 1487105482 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONI LODGE CEO 509-325-5502 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) (Licence: WA 601182805) |
| Additional Taxonomies | 332800000X Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy (Licence: WA 601182805) |
| 3336C0002X Pharmacy Clinic Pharmacy (Licence: WA 601182805) | |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2016-10-14 |