Organization
WILLIAMS MEDCO INC
Active
Other names
William's Fairway Drug #1162
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK L. HOLT RPH (OWNER)
(503) 981-3591
Entity
Organization
Contact information
Practice address
2515 NEWBURG HWY, WOODBURN, OR 97071
(503) 981-3591
(503) 982-0566
Mailing address
916 W EVERGREEN BLVD, VANCOUVER, WA 98660
(360) 213-2236
(360) 213-2238
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
RP-0000585-CS
OR
333600000X
Pharmacy
Primary
RP0000585CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119680
—
OR
01
—
38-11216
NCPDP
—
Enumeration date
08/29/2005
Last updated
11/01/2010
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