Healthcare Provider Details

I. General information

NPI: 1043347933
Provider Name (Legal Business Name): RXTRA CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4831 35TH AVE SW
SEATTLE WA
98126-2709
US

IV. Provider business mailing address

4831 35TH AVE SW
SEATTLE WA
98126-2709
US

V. Phone/Fax

Practice location:
  • Phone: 206-938-6196
  • Fax: 206-938-6197
Mailing address:
  • Phone: 206-938-6196
  • Fax: 206-938-6197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number StateWA

VIII. Authorized Official

Name: DR. MICHEAL J. HENRY
Title or Position: PHARMACY MANAGER
Credential: PD
Phone: 206-938-6196