Healthcare Provider Details

I. General information

NPI: 1073604039
Provider Name (Legal Business Name): YAKIMA VALLEY FARM WORKERS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WALLACE WAY
GRANDVIEW WA
98930-8805
US

IV. Provider business mailing address

2601 COMMERCE LN
YAKIMA WA
98901-5801
US

V. Phone/Fax

Practice location:
  • Phone: 509-882-3977
  • Fax: 509-882-2966
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 NumberCF00055922
License Number StateWA

VIII. Authorized Official

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