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General NPI Number Information
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NPI Number | 1700245511
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Entity Type | Organization
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Legal Business Name | OUR LADY OF LOURDES HEALTH CENTER
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Dates
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Enumeration Date | 02/22/2016
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Last Update Date | 07/20/2016
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Provider Practice Location Address
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Address Line | 1175 CARONDELET DR ATTN: PHARMACY
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City | RICHLAND
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State | WA
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Zip | 99354-3300
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Country | US
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Telephone | 509-946-7108
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Fax | 509-543-2414
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Provider Business Mailing Address
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Address Line | ATTN: PHARMACY 1175 CARONDELET DRIVE
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City | RICHLAND
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State | WA
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Zip | 99354
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Country | US
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Telephone | 509-946-7108
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Fax | 509-543-2414
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Authorized Official
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Title or Position | PIC/DIRECTOR OF PHARMACY
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Name | TRACY CLARK
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Credential |
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Telephone | 509-546-2298
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | PHAR.CF.6048122
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License Number State | WA
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