Individual
CHI MAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
140 E MAIN ST, OTHELLO, WA 99344-1040
(509) 488-5256
Mailing address
140 E MAIN ST, OTHELLO, WA 99344-1040
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH60475903
WA
Other
Enumeration date
02/27/2015
Last updated
02/27/2015
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