Healthcare Provider Details

I. General information

NPI: 1295139640
Provider Name (Legal Business Name): AMY WAHL PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 S WHITCOMB AVE
TONASKET WA
98855-8824
US

IV. Provider business mailing address

PO BOX 711
TONASKET WA
98855-0711
US

V. Phone/Fax

Practice location:
  • Phone: 509-486-9120
  • Fax: 509-486-9099
Mailing address:
  • Phone: 509-486-9120
  • Fax: 509-486-9099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00021059
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: