Healthcare Provider Details

I. General information

NPI: 1265466023
Provider Name (Legal Business Name): RXTRA CARE HOME MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 148TH AVE SE
BELLEVUE WA
98007
US

IV. Provider business mailing address

7317 35TH AVE NE
SEATTLE WA
98115
US

V. Phone/Fax

Practice location:
  • Phone: 425-747-3801
  • Fax: 425-373-1786
Mailing address:
  • Phone: 206-417-8066
  • Fax: 206-417-8076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: HOLLIS W HENRY
Title or Position: PRESIDENT
Credential: PHARMACIST
Phone: 206-417-8066