Healthcare Provider Details

I. General information

NPI: 1104838572
Provider Name (Legal Business Name): REIDT PHARMACY CORPERATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W RIVERSIDE AVE STE. 140
SPOKANE WA
99201-0621
US

IV. Provider business mailing address

601 W RIVERSIDE AVE STE. 140
SPOKANE WA
99201-0621
US

V. Phone/Fax

Practice location:
  • Phone: 509-624-2111
  • Fax: 509-624-9500
Mailing address:
  • Phone: 509-624-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberCF00058331
License Number StateWA

VIII. Authorized Official

Name: MR. DANIEL J REIDT
Title or Position: OWNER/PHARMACIST
Credential: PHARM.D.
Phone: 509-624-2111