MEDICARE: WALLA WALLA VAMC

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	332100000X	Department of Veterans Affairs (VA) Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4912653	OTHER	WA	NCPDP#

General Provider Information

NPI Number	:	1477501666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALLA WALLA VAMC

Provider Business Mailing Address
First Line	:	PO BOX 94423
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44101-4423
Country	:	US
Telephone Number	:	702-341-3164
Fax Number	:

Provider Business Practice Location Address
First Line	:	77 WAINWRIGHT DR
Second Line	:
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-3975
Country	:	US
Telephone Number	:	509-525-5200
Fax Number	:	509-527-6137

Authorized Official
Title or Position	:	NPI TEAM MEMBER
Name	:	ERIN DENISE POTTER
Credential	:
Telephone Number	:	202-382-2579

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	10/24/2018

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