Healthcare Provider Details

I. General information

NPI: 1831285162
Provider Name (Legal Business Name): YAKIMA VALLEY FARM WORKERS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W MISSION AVE
SPOKANE WA
99201-2322
US

IV. Provider business mailing address

2601 COMMERCE LN
YAKIMA WA
98901-5801
US

V. Phone/Fax

Practice location:
  • Phone: 509-323-8757
  • Fax: 509-326-0739
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 NumberCF00057072
License Number StateWA

VIII. Authorized Official

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