Healthcare Provider Details

I. General information

NPI: 1801817861
Provider Name (Legal Business Name): REDDI ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 SW 43RD ST STE 120
RENTON WA
98057-4803
US

IV. Provider business mailing address

1412 SW 43RD ST STE 120
RENTON WA
98057-4803
US

V. Phone/Fax

Practice location:
  • Phone: 425-251-6335
  • Fax: 425-251-6337
Mailing address:
  • Phone: 425-251-6335
  • Fax: 425-251-6337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHAR.CF.00058343
License Number StateWA

VIII. Authorized Official

Name: ANDERSON JOLLY
Title or Position: PRESIDENT
Credential:
Phone: 425-251-6335