=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619056660
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RP HEALTHCARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2006
-----------------------------------------------------
Last Update Date | 02/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2456 W 3RD ST
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95401-6425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-571-5955
-----------------------------------------------------
Fax | 707-571-5951
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2456 W 3RD ST
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95401-6425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-571-5955
-----------------------------------------------------
Fax | 707-571-5951
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | MR. JOHN R O'CONNELL
-----------------------------------------------------
Credential | M.S, RPH
-----------------------------------------------------
Telephone | 707-571-5955
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number | PHY45623
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------