NPI | 1699184366 |
---|---|
Entity Type | Organization |
Authorized Contact | TONI LODGE Executive Director 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 | 2014-08-07 |
Last Update Date | 2016-01-07 |