Provider Demographics
NPI:1568719359
Name:YAKIMA VALLEY MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:YAKIMA VALLEY MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:MULTICARE PHARMACY - CORNERSTONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUYOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-575-8001
Mailing Address - Street 1:4003 WEST CREEKSIDE LOOP
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908
Mailing Address - Country:US
Mailing Address - Phone:509-573-3808
Mailing Address - Fax:509-573-3809
Practice Address - Street 1:4003 CREEKSIDE LOOP
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908
Practice Address - Country:US
Practice Address - Phone:509-573-3808
Practice Address - Fax:509-573-3809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-10
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPHAR.CF.60509437333600000X, 3336C0002X, 3336S0011X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2023584Medicaid
WA4934774OtherNCPDP