MEDICARE: MR. CHRISTOPHER SHAWN CLOSE BSC. PHARMACY RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH60123574	WA

General Provider Information

NPI Number	:	1720388028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER SHAWN CLOSE BSC. PHARMACY RPH

Provider Business Mailing Address
First Line	:	1600 PLAZA WAY
Second Line	:
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-4325
Country	:	US
Telephone Number	:	509-522-4672
Fax Number	:	509-525-8985

Provider Business Practice Location Address
First Line	:	1600 PLAZA WAY
Second Line	:
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-4325
Country	:	US
Telephone Number	:	509-522-4672
Fax Number	:	509-525-8985

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2010
Last Update Date	:	11/02/2010

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