| NPI | 1639162217 |
|---|---|
| Doing Business As | WILLIAM'S FAIRWAY DRUG #1162 |
| Entity Type | Organization |
| Authorized Contact | JACK L. HOLT Owner 503-981-3591 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: OR RP0000585CS) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: OR RP-0000585-CS) |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2010-11-01 |