Provider Demographics
NPI:1700245511
Name:OUR LADY OF LOURDES HEALTH CENTER
Entity Type:Organization
Organization Name:OUR LADY OF LOURDES HEALTH CENTER
Other - Org Name:LOURDES COUNSELING CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC/DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-546-2298
Mailing Address - Street 1:ATTN: PHARMACY
Mailing Address - Street 2:1175 CARONDELET DRIVE
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354
Mailing Address - Country:US
Mailing Address - Phone:509-946-7108
Mailing Address - Fax:509-543-2414
Practice Address - Street 1:1175 CARONDELET DR
Practice Address - Street 2:ATTN: PHARMACY
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-3300
Practice Address - Country:US
Practice Address - Phone:509-946-7108
Practice Address - Fax:509-543-2414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WAPHAR.CF.60481223336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160592OtherPK