MEDICARE: COMMUNITY HEALTH ASSOC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	60117246	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4933607	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1093043465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY HEALTH ASSOC

Provider Business Mailing Address
First Line	:	203 N WASHINGTON ST STE 300
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-0233
Country	:	US
Telephone Number	:	509-444-8888
Fax Number	:	509-444-7806

Provider Business Practice Location Address
First Line	:	800 6TH ST
Second Line	:
City	:	CLARKSTON
State	:	WA
Zip	:	99403-2013
Country	:	US
Telephone Number	:	509-758-2565
Fax Number	:	509-758-2151

Authorized Official
Title or Position	:	DEPUTY DIRECTOR
Name	:	AARON WILSON
Credential	:
Telephone Number	:	509-444-8888

Provider Enumeration Date	:	11/24/2009
Last Update Date	:	11/24/2009

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Directions to “COMMUNITY HEALTH ASSOC ” Practice Location

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