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General NPI Number Information
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NPI Number | 1568908978
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Entity Type | Organization
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Legal Business Name | YAKIMA VALLEY FARM WORKERS CLINIC
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Dates
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Enumeration Date | 01/09/2017
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | 255 LANCASTER DR NE
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City | SALEM
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State | OR
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Zip | 97301-5155
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Country | US
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Telephone | 503-576-8400
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Fax | 503-364-0775
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Provider Business Mailing Address
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Address Line | 2601 COMMERCE LN
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City | YAKIMA
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State | WA
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Zip | 98901-5801
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Country | US
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Telephone | 509-865-6175
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Fax | 509-865-0840
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Authorized Official
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Title or Position | COO
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Name | GLEN DAVIS
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Credential |
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Telephone | 509-865-6175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | RP-0003226
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License Number State | OR
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