Odessa Drugs

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

CF00004908 Issued in WA

Legal business name

ODESSA DRUGS

Practice address

19 W. 1St Ave.
Odessa, WA 99159-0189

Phone

(509) 982-2541

Fax

(509) 982-2660

NPI assigned

Mar 2, 2007

Last updated

Mar 7, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Ted J Bruya, RPH

Title

Owner

Phone

(509) 982-2541

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1689702326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 W. 1ST AVE.",
            "address_2": "PO BOX 189",
            "city": "ODESSA",
            "state": "WA",
            "postal_code": "991590189",
            "telephone_number": "509-982-2541",
            "fax_number": "509-982-2660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 W. 1ST AVE.",
            "city": "ODESSA",
            "state": "WA",
            "postal_code": "991590189",
            "telephone_number": "509-982-2541",
            "fax_number": "509-982-2660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ODESSA DRUGS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-02",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "BRUYA",
        "authorized_official_first_name": "TED",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-982-2541",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WA",
            "license": "CF00004908",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6014088",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON L&I NUMBER",
            "identifier": "0051984",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lincoln County Public Hospital District 1 (Odessa Memorial Healthcare Center Health Homes)
• Lincoln County Public Hospital District 1 (Odessa Memorial Healthcare Center)
• Lincoln County Public Hospital District 1 (Odessa Clinic)
• Mario Cesar Montano, MSW
• Janelle Rae Moore
• Odessa School District
• Providence Health & Services - Washington (Providence Spokane Heart Institute)
• Violet Frances Rice, FNP
• Patricia A Rosman, DDS
• Kerri Ruddell, NP

• Community/Retail Pharmacy in Odessa, WA
• Providers in Odessa, WA by specialty
• Community/Retail Pharmacy in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.