Organization
ODESSA DRUGS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TED J BRUYA RPH (OWNER)
(509) 982-2541
Entity
Organization
Contact information
Practice address
19 W. 1ST AVE., ODESSA, WA 99159-0189
(509) 982-2541
(509) 982-2660
Mailing address
19 W. 1ST AVE., PO BOX 189, ODESSA, WA 99159-0189
(509) 982-2541
(509) 982-2660
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
CF00004908
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0051984
WASHINGTON L&I NUMBER
WA
05
—
6014088
—
WA
Enumeration date
03/02/2007
Last updated
03/07/2023
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