Organization
PROSSER SOUTHGATE PHARMACY INC
Active
Other names
Prosser Southgate Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
LATEEF A. OLANIYAN RPH, PHARMD (PRESIDENT)
(509) 750-8319
Entity
Organization
Contact information
Practice address
207 CANYON DRIVE, PROSSER, WA 99350-1009
(509) 750-8319
(509) 765-4761
Mailing address
2709 W. BROADWAY AVENUE, MOSES LAKE, WA 98837
(509) 750-8319
(509) 765-4761
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
01/28/2020
Last updated
01/28/2020
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