Provider Demographics
NPI:1235291725
Name:HUTTULA ENTERPRISES INC
Entity Type:Organization
Organization Name:HUTTULA ENTERPRISES INC
Other - Org Name:ELMA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:B
Authorized Official - Last Name:HUTTULA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-482-2442
Mailing Address - Street 1:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:WA
Mailing Address - Zip Code:98541-0577
Mailing Address - Country:US
Mailing Address - Phone:360-482-2442
Mailing Address - Fax:360-482-4688
Practice Address - Street 1:221 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:WA
Practice Address - Zip Code:98541-0577
Practice Address - Country:US
Practice Address - Phone:360-482-2442
Practice Address - Fax:360-482-4688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF000035113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6020754Medicaid
4903452OtherNCPDP NUMBER
0482980001Medicare NSC