Healthcare Provider Details

I. General information

NPI: 1902067770
Provider Name (Legal Business Name): RELIANT RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S COWLEY ST
SPOKANE WA
99202-1500
US

IV. Provider business mailing address

125 S COWLEY ST
SPOKANE WA
99202-1500
US

V. Phone/Fax

Practice location:
  • Phone: 509-343-3400
  • Fax: 509-370-7323
Mailing address:
  • Phone: 509-343-3400
  • Fax: 509-370-7323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberMTS-5217
License Number StateWA

VIII. Authorized Official

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