Healthcare Provider Details

I. General information

NPI: 1376086587
Provider Name (Legal Business Name): RESPACK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18110 SE 34TH ST BLDG 2
VANCOUVER WA
98683-9440
US

IV. Provider business mailing address

18110 SE 34TH ST STE 290
VANCOUVER WA
98683-9418
US

V. Phone/Fax

Practice location:
  • Phone: 800-330-3665
  • Fax: 800-982-2730
Mailing address:
  • Phone: 800-330-3665
  • Fax: 800-982-2730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHA-MOP-LIC-50122
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberRP-0003332-CS
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberNR-51309
License Number StateWY
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number44154MS
License Number StateID
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHAR.FC.6068072
License Number StateWA

VIII. Authorized Official

Name: BRIAN IKEDA
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 800-330-3665