Healthcare Provider Details

I. General information

NPI: 1962579185
Provider Name (Legal Business Name): ULRICH VALLEY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 12/21/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 E METHOW VALLEY HWY
TWISP WA
98856
US

IV. Provider business mailing address

PO BOX 37
TWISP WA
98856-0037
US

V. Phone/Fax

Practice location:
  • Phone: 509-997-2191
  • Fax: 509-997-9205
Mailing address:
  • Phone: 509-997-2191
  • Fax: 509-997-9205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberCF00000885
License Number StateWA

VIII. Authorized Official

Name: MR. ROBERT WINTON ULRICH
Title or Position: CEO
Credential: RPH
Phone: 509-997-2191