# WALLOWA PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730242421
- **Authorized official:** MR. JEAN WAYNE FOSTER R.PH (OWNER)
- **Authorized official phone:** (541) 886-2361

## Contact information

- **Practice address:** 207 EAST 1ST ST., WALLOWA, OR 97885
- **Practice address phone:** (541) 886-2361
- **Practice address fax:** (541) 886-6801
- **Mailing address:** PO BOX 38, WALLOWA, OR 97885
- **Mailing address phone:** (541) 886-2361
- **Mailing address fax:** (541) 886-6801

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | RP0000584CS | OR | Yes |

## Other

- **Enumeration date:** 12/18/2006
- **Last updated:** 03/19/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 179317 | — | OR |