Provider Demographics
NPI: | 1700834900 |
---|---|
Name: | WHITE CITY VAMC |
Entity Type: | Organization |
Organization Name: | WHITE CITY VAMC |
Other - Org Name: | WHITE CITY VAMC PHARMACY |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | NPI TEAM MEMBER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | ERIN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | POTTER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 202-382-2579 |
Mailing Address - Street 1: | PO BOX 94425 |
Mailing Address - Street 2: | |
Mailing Address - City: | CLEVELAND |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 44101-4425 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 702-341-3164 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 8495 CRATER LAKE HWY |
Practice Address - Street 2: | |
Practice Address - City: | WHITE CITY |
Practice Address - State: | OR |
Practice Address - Zip Code: | 97503-3011 |
Practice Address - Country: | US |
Practice Address - Phone: | 541-830-7563 |
Practice Address - Fax: | 541-830-3504 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-04 |
Last Update Date: | 2019-09-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332100000X | Suppliers | Department of Veterans Affairs (VA) Pharmacy |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OR | 3812206 | Other | NCPDP# |