Basic Information
| Provider Information | |||||||||
| NPI: | 1164551164 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YAKAMA INDIAN HEALTH CENTER PHARMACY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 BUSTER RD | ||||||||
| Address2: | |||||||||
| City: | TOPPENISH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989489792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098651703 | ||||||||
| FaxNumber: | 5098658753 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 BUSTER RD | ||||||||
| Address2: | |||||||||
| City: | TOPPENISH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989489792 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098651703 | ||||||||
| FaxNumber: | 5098658753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BATTESE | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | AREA BUSINESS OFFICE COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 5033267277 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332800000X | Y | Suppliers | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 4926311 | 01 | NCPDP NUMBER | OTHER | AW3308574 | 01 | PHARMACY DEA | OTHER | 6021174 | 05 | WA | MEDICAID |