Healthcare Provider Details

I. General information

NPI: 1992276794
Provider Name (Legal Business Name): HUTTULA ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 E MAIN ST SUITE 200
ELMA WA
98541
US

IV. Provider business mailing address

PO BOX 558
ELMA WA
98541-0558
US

V. Phone/Fax

Practice location:
  • Phone: 360-861-8670
  • Fax: 360-861-8620
Mailing address:
  • Phone: 360-861-8670
  • Fax: 360-861-8620

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: MR. MICHAEL THOMAS HUTTULA
Title or Position: PHARMACIST IN CHARGE (PIC)
Credential: PHARMD
Phone: 360-861-8670