NPIMap

Organization Active NPI

Tieton Village Drugs Inc

  • Community/Retail Pharmacy
  • Yakima, WA
National Provider Identifier
1831110808
Registry record updated Sep 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
CF00058481 Issued in WA
Legal business name
TIETON VILLAGE DRUGS INC
Practice address
4040 Terrace Heights Dr
Ste 120
Yakima, WA 98901-1424
Phone
(509) 248-3311
Fax
(509) 248-3322
NPI assigned
Jul 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2013

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

Authorized official

Name
Ryan Davis
Title
GM
Phone
(509) 469-3198

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X CF00058481 WA Primary

Addresses

Primary practice location

4040 Terrace Heights Dr
Ste 120
Yakima, WA 98901-1424

Mailing address

3708 Tieton Dr
Yakima, WA 98902-3664
Phone (509) 469-3198

Other identifiers 2

IdentifierTypeStateIssuer
6028955MedicaidWA
2108645OtherPK

Other names 1

  • TERRACE VILLAGE PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Tieton Village Drug5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4040 Terrace Heights Dr
Ste 120
Yakima, WA 98901
Phone (509) 248-3311

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379376000000",
    "number": "1831110808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3708 TIETON DR",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989023664",
            "telephone_number": "509-469-3198",
            "fax_number": "509-469-3205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4040 TERRACE HEIGHTS DR",
            "address_2": "STE 120",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989011424",
            "telephone_number": "509-248-3311",
            "fax_number": "509-248-3322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIETON VILLAGE DRUGS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2013-09-17",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "GM",
        "authorized_official_telephone_number": "509-469-3198"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WA",
            "license": "CF00058481",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6028955",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2108645",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TERRACE VILLAGE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yakima, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2013; 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.