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General NPI Number Information
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NPI Number | 1730242421
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Entity Type | Organization
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Legal Business Name | WALLOWA PHARMACY
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 03/19/2008
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Provider Practice Location Address
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Address Line | 207 EAST 1ST ST.
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City | WALLOWA
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State | OR
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Zip | 97885
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Country | US
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Telephone | 541-886-2361
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Fax | 541-886-6801
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Provider Business Mailing Address
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Address Line | PO BOX 38
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City | WALLOWA
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State | OR
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Zip | 97885
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Country | US
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Telephone | 541-886-2361
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Fax | 541-886-6801
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Authorized Official
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Title or Position | OWNER
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Name | MR. JEAN WAYNE FOSTER
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Credential | R.PH
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Telephone | 541-886-2361
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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 | RP0000584CS
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License Number State | OR
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