Basic Information
| Provider Information | |||||||||
| NPI: | 1447267489 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | YAKIMA VLY FARM WORKERS PHCY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 518 W 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | TOPPENISH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989481564 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 518 W 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | TOPPENISH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989481564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098655600 | ||||||||
| FaxNumber: | 5098652316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BUCHNAM | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF OPS OFC | ||||||||
| AuthorizedOfficialTelephone: | 5098655600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RPH | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | FO00001916 | WA | X | Suppliers | Pharmacy | 3336C0002X | X | Suppliers | Pharmacy | Clinic Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 6008957 | 05 | WA | MEDICAID | 4914025 | 01 | OTHER ID NUMBER-COMMERCIAL NUMBER | OTHER |