Provider Demographics
NPI:1437193570
Name:COLUMBIA VALLEY COMMUNITY HEALTH
Entity Type:Organization
Organization Name:COLUMBIA VALLEY COMMUNITY HEALTH
Other - Org Name:COLUMBIA VALLEY COMMUNITY HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-664-3528
Mailing Address - Street 1:600 ORONDO AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2800
Mailing Address - Country:US
Mailing Address - Phone:509-662-6000
Mailing Address - Fax:509-664-4590
Practice Address - Street 1:600 ORONDO AVE STE 1
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2800
Practice Address - Country:US
Practice Address - Phone:509-664-3508
Practice Address - Fax:509-664-4591
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:601-108-231
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF000563883336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACF00056388OtherCOMMUNITY PHARMACY
WA6022313Medicaid
BC6479542OtherDEA LICENSE
WACF00056388OtherCOMMUNITY PHARMACY