Healthcare Provider Details

I. General information

NPI: 1184001935
Provider Name (Legal Business Name): RELIANT RX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

767 WILLIAMS BLVD
RICHLAND WA
99354-3221
US

IV. Provider business mailing address

2820 N ASTOR ST
SPOKANE WA
99207-2112
US

V. Phone/Fax

Practice location:
  • Phone: 866-440-5457
  • Fax: 844-340-7322
Mailing address:
  • Phone: 509-343-3400
  • Fax: 509-340-7323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHAR.CF.60558051
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPHAR.CF.60558051
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHAR.CF.60558051
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHAR.CF.60558051
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHAR.CF.60558051
License Number StateWA

VIII. Authorized Official

Name: MRS. TAMMY MARIE KROETCH
Title or Position: CEO
Credential:
Phone: 509-343-3400