Provider Demographics
NPI:1376672352
Name:WARM SPRINGS HEALTH AND WELLNESS CENTER PHARMACY
Entity Type:Organization
Organization Name:WARM SPRINGS HEALTH AND WELLNESS CENTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AREA BUSINESS OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BATTESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-326-7277
Mailing Address - Street 1:1270 KOT-NUM RD
Mailing Address - Street 2:PO BOX 1209
Mailing Address - City:WARM SPRINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97761
Mailing Address - Country:US
Mailing Address - Phone:541-553-2134
Mailing Address - Fax:541-553-2481
Practice Address - Street 1:1270 KOT-NUM RD
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:OR
Practice Address - Zip Code:97761
Practice Address - Country:US
Practice Address - Phone:541-553-2134
Practice Address - Fax:541-553-2481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3813208OtherNCPDP NUMBER
OR139290Medicaid
AP5007580OtherPHARMACY DEA NUMBER