Healthcare Provider Details

I. General information

NPI: 1063516011
Provider Name (Legal Business Name): MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 W SPRUCE ST
YAKIMA WA
98902-3210
US

IV. Provider business mailing address

1112 W SPRUCE ST
YAKIMA WA
98902-3210
US

V. Phone/Fax

Practice location:
  • Phone: 509-453-4835
  • Fax: 509-453-7691
Mailing address:
  • Phone: 509-453-4835
  • Fax: 509-453-7691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberCF00002290
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RICHARD HESTER
Title or Position: PRES
Credential: PPH
Phone: 509-453-4835