Healthcare Provider Details

I. General information

NPI: 1780746396
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: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 W. MAIN ST.
ELMA WA
98541-0597
US

IV. Provider business mailing address

PO BOX 597
ELMA WA
98541-0597
US

V. Phone/Fax

Practice location:
  • Phone: 360-482-2512
  • Fax: 360-482-2010
Mailing address:
  • Phone: 360-482-2512
  • Fax: 360-482-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberCF00057742
License Number StateWA

VIII. Authorized Official

Name: TOM B HUTTULA
Title or Position: PRESIDENT
Credential: RPH
Phone: 360-482-2512