Healthcare Provider Details

I. General information

NPI: 1073722526
Provider Name (Legal Business Name): YAKIMA VALLEY FARMWORKERS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S 11TH AVE SUITE F
YAKIMA WA
98902-3248
US

IV. Provider business mailing address

215 S 11TH AVE SUITE F
YAKIMA WA
98902
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-4315
  • Fax: 509-469-2365
Mailing address:
  • Phone: 509-575-4315
  • Fax: 509-469-2365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberF000055798
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00011366
License Number StateWA

VIII. Authorized Official

Name: MR. KLAUS PETER TOOP
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 509-865-5898