Individual
JACKIE MARY WIDHALM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
5801 SUMMITVIEW AVE, YAKIMA, WA 98908-3006
(509) 965-6393
(509) 965-5966
Mailing address
5801 SUMMITVIEW AVE, YAKIMA, WA 98908-3006
(509) 965-6393
(509) 965-5966
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PH00015720
WA
Other
Enumeration date
02/08/2012
Last updated
02/08/2012
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