Organization
TIETON VILLAGE DRUGS INC
Active
Other names
TERRACE VILLAGE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN DAVIS (GM)
(509) 469-3198
Entity
Organization
Contact information
Practice address
4040 TERRACE HEIGHTS DR, STE 120, YAKIMA, WA 98901-1424
(509) 248-3311
(509) 248-3322
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
CF00058481
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2108645
PK
—
05
—
6028955
—
WA
Enumeration date
07/22/2006
Last updated
09/17/2013
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