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General NPI Number Information
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NPI Number | 1962461350
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Entity Type | Organization
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Legal Business Name | WMSO LLC
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 01/20/2011
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Provider Practice Location Address
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Address Line | 661 SE BASELINE ST
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City | HILLSBORO
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State | OR
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Zip | 97123-4115
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Country | US
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Telephone | 503-681-0735
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Fax | 503-693-0655
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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 | 360-213-2236
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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 | RP0001029CS
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License Number State | OR
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