Organization
CLINIC AT ROYAL CITY
Active
Other names
CLINIC AT ROYAL CITY
Organization subpart
No
Provider details
NPI number
Authorized official
DIRENDIA SHACKELFORD (MANAGED CARE SPECIALIST)
(800) 654-0889
Entity
Organization
Contact information
Practice address
101 CAMELIA ST NW, ROYAL CITY, WA 99357
(509) 346-1447
(509) 346-1481
Mailing address
PO BOX 1028, ROYAL CITY, WA 99357-1028
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
MD00010548
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4928137
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
8213605
—
WA
Enumeration date
10/24/2006
Last updated
08/22/2020
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