Organization
WALLOWA PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEAN WAYNE FOSTER R.PH (OWNER)
(541) 886-2361
Entity
Organization
Contact information
Practice address
207 EAST 1ST ST., WALLOWA, OR 97885
(541) 886-2361
(541) 886-6801
Mailing address
PO BOX 38, WALLOWA, OR 97885
(541) 886-2361
(541) 886-6801
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
RP0000584CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
179317
—
OR
Enumeration date
12/18/2006
Last updated
03/19/2008
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