Organization
COLUMBIA BASIN HEALTH ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NIEVES GOMEZ (CEO)
(509) 488-5256
Entity
Organization
Contact information
Practice address
1515 E COLUMBIA ST, OTHELLO, WA 99344-1846
(509) 488-5256
(509) 488-9939
Mailing address
1515 E COLUMBIA ST, OTHELLO, WA 99344-1846
(509) 488-5256
(509) 488-9939
Taxonomy
Speciality
Code
Description
License number
State
3336S0011X
Specialty Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1014705
—
WA
01
—
PH.CF.61335712
DOH LICENSE
WA
Enumeration date
05/04/2022
Last updated
07/13/2022
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