Healthcare Provider Details

I. General information

NPI: 1235291725
Provider Name (Legal Business Name): HUTTULA ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W. MAIN ST.
ELMA WA
98541-0577
US

IV. Provider business mailing address

PO BOX 577
ELMA WA
98541-0577
US

V. Phone/Fax

Practice location:
  • Phone: 360-482-2442
  • Fax: 360-482-4688
Mailing address:
  • Phone: 360-482-2442
  • Fax: 360-482-4688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberCF00003511
License Number StateWA

VIII. Authorized Official

Name: MR. TOM B HUTTULA
Title or Position: PRESIDENT
Credential: RPH
Phone: 360-482-2442