Individual
MAN HA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
401 W POPLAR ST, WALLA WALLA, WA 99362-2846
(509) 897-2696
Mailing address
336 S PALOUSE ST APT 3, WALLA WALLA, WA 99362-3045
(518) 645-2235
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH61451761
WA
Other
Enumeration date
10/30/2023
Last updated
10/30/2023
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