Provider Demographics
NPI:1942300926
Name:YAKIMA VALLEY MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:YAKIMA VALLEY MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:MULTICARE CANCER CENTER PHARMACY - NORTH STAR LODGE
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 1:2811 TIETON DR
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3761
Mailing Address - Country:US
Mailing Address - Phone:509-574-5965
Mailing Address - Fax:
Practice Address - Street 1:808 N 39TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-6388
Practice Address - Country:US
Practice Address - Phone:509-574-3404
Practice Address - Fax:509-574-3420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF00056595333600000X
WAPHAR.CF.00056595333600000X, 3336C0002X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4928315OtherNCPDP
WA1046311Medicaid
WA6024541Medicaid
=========OtherTAX ID
WA0474340002Medicare NSC