| NPI | 1619193570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARGARET GOODMAN Pharmacy Coordinator 360-716-2664 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332800000X Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
| Additional Taxonomies | 333600000X Pharmacy (Licence: WA CF00055944) |
| 3336C0002X Pharmacy, Clinic Pharmacy (Licence: WA CF00055944) | |
| 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: WA CF00055944) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2021-07-21 |