| NPI | 1659450336 |
|---|---|
| Doing Business As | TIETON VILLAGE DRUG |
| Entity Type | Organization |
| Authorized Contact | RYAN DAVIS Gen Mgr 509-469-3198 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: WA CF00056158) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2013-09-18 |