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General NPI Number Information
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NPI Number | 1275098709
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Entity Type | Organization
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Legal Business Name | EMPIRESRX
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Dates
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Enumeration Date | 02/08/2019
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Last Update Date | 02/08/2019
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Provider Practice Location Address
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Address Line | 315 S. WHITCOMB AVE
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City | TONASKET
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State | WA
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Zip | 98855
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Country | US
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Telephone | 509-486-0123
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Fax | 509-486-0124
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Provider Business Mailing Address
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Address Line | PO BOX 871
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City | OMAK
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State | WA
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Zip | 98841-0871
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Country | US
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Telephone | 509-631-1453
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Fax |
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | DINESH GAJJALA
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Credential | RPH
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Telephone | 509-631-1453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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