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General NPI Number Information
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NPI Number | 1083674279
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Entity Type | Organization
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Legal Business Name | WSG CORP
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 11/20/2009
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Provider Practice Location Address
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Address Line | 301 SE 6TH ST
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City | GRANTS PASS
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State | OR
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Zip | 97526-2503
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Country | US
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Telephone | 541-476-4464
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Fax | 541-476-4222
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Provider Business Mailing Address
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Address Line | 916 W EVERGREEN BLVD
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City | VANCOUVER
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State | WA
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Zip | 98660-3035
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Country | US
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Telephone | 360-213-2236
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Fax | 360-213-2238
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Authorized Official
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Title or Position | OWNER
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Name | MR. WINFIELD F MUFFETT III
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Credential | RPH
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Telephone | 360-693-5879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | RP0000219CS
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License Number State | OR
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