=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043347933
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RXTRA CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2007
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4831 35TH AVE SW
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98126-2709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-938-6196
-----------------------------------------------------
Fax | 206-938-6197
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4831 35TH AVE SW
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98126-2709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-938-6196
-----------------------------------------------------
Fax | 206-938-6197
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACY MANAGER
-----------------------------------------------------
Name | DR. MICHEAL J. HENRY
-----------------------------------------------------
Credential | PD
-----------------------------------------------------
Telephone | 206-938-6196
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------