Organization
TIETON VILLAGE DRUG INC.
Active
Other names
TIETON VILLAGE DRUG
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN DAVIS (GEN MGR)
(509) 469-3198
Entity
Organization
Contact information
Practice address
3708 TIETON DR, YAKIMA, WA 98902-3664
(509) 966-6850
(509) 966-2690
Mailing address
3708 TIETON DR, YAKIMA, WA 98902-3664
(509) 469-3198
(509) 469-3205
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
CF00056158
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2106408
PK
—
05
—
6712209
—
WA
Enumeration date
11/03/2006
Last updated
09/18/2013
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