Healthcare Provider Details

I. General information

NPI: 1124480074
Provider Name (Legal Business Name): HUTTULA ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2016
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W SIMPSON AVE
MCCLEARY WA
98557
US

IV. Provider business mailing address

PO BOX 88
MCCLEARY WA
98557-0088
US

V. Phone/Fax

Practice location:
  • Phone: 360-495-0700
  • Fax: 360-495-0011
Mailing address:
  • Phone: 360-495-0700
  • Fax: 360-495-0011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHAR.CF.60625079
License Number StateWA

VIII. Authorized Official

Name: TOM HUTTULA
Title or Position: OWNER, PRESIDENT, PIC, AO
Credential:
Phone: 360-495-0700