Healthcare Provider Details

I. General information

NPI: 1861423717
Provider Name (Legal Business Name): COLUMBIA RIVER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 01/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 GEORGE WASHINGTON WAY
RICHLAND WA
99354-2308
US

IV. Provider business mailing address

1906 GEORGE WASHINGTON WAY
RICHLAND WA
99354-2308
US

V. Phone/Fax

Practice location:
  • Phone: 509-943-9173
  • Fax: 509-946-1122
Mailing address:
  • Phone: 509-943-9173
  • Fax: 509-946-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHAR.CF.60176819
License Number StateWA

VIII. Authorized Official

Name: JAMES HENRIKSEN
Title or Position: OWNER
Credential: PHARMD
Phone: 509-943-9173