Organization
TIETON VILLAGE DRUG INC.
Active
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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