=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891070850
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICK KENNETH MELCHER RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2011
-----------------------------------------------------
Last Update Date | 10/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2310 LONGFIBRE ROAD
-----------------------------------------------------
City | UNION GAP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-454-4249
-----------------------------------------------------
Fax | 509-454-5426
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4507 KIMBERLY PLACE
-----------------------------------------------------
City | YAKIMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-248-3310
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PL00011391
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------