NPI: 1003921453 · WHITE CITY, OR 97503 · Community/Retail Pharmacy · NPI assigned 08/19/2006
| Authorized Official | DONOVAN, COREY (GENERAL MANAGER) |
| NPI Enumeration Date | 08/19/2006 |
| Year | Claims | Total Paid |
|---|---|---|
| 2021 | 14 | $0.00 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| 0012A | 14 | 12 | $0.00 |