Provider Demographics
NPI:1780746396
Name:HUTTULA ENTERPRISES INC
Entity type:Organization
Organization Name:HUTTULA ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:B
Authorized Official - Last Name:HUTTULA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:360-482-2512
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:WA
Mailing Address - Zip Code:98541-0597
Mailing Address - Country:US
Mailing Address - Phone:360-482-2512
Mailing Address - Fax:360-482-2010
Practice Address - Street 1:402 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:WA
Practice Address - Zip Code:98541-0597
Practice Address - Country:US
Practice Address - Phone:360-482-2512
Practice Address - Fax:360-482-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF000577423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4903440OtherNCPDP
WA6009302Medicaid
WA6009302Medicaid