Healthcare Provider Details

I. General information

NPI: 1649211509
Provider Name (Legal Business Name): RXTRA CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7317 35TH AVE NE
SEATTLE WA
98115-5918
US

IV. Provider business mailing address

7317 35TH AVE NE
SEATTLE WA
98115-5918
US

V. Phone/Fax

Practice location:
  • Phone: 206-417-8066
  • Fax: 206-417-8076
Mailing address:
  • Phone: 206-417-8066
  • Fax: 206-417-8076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberCF.00057811
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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