Healthcare Provider Details

I. General information

NPI: 1285290924
Provider Name (Legal Business Name): YAKIMA VALLEY FARM WORKERS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2019
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

589 NW 11TH ST
HERMISTON OR
97838-6600
US

IV. Provider business mailing address

2601 COMMERCE LN
YAKIMA WA
98901-5801
US

V. Phone/Fax

Practice location:
  • Phone: 541-564-5176
  • Fax: 541-567-6860
Mailing address:
  • Phone: 509-865-6175
  • Fax: 509-865-0840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: GLEN DAVIS
Title or Position: COO
Credential:
Phone: 509-865-6175