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NPI Code Detail

MEDICARE: JOHN RACKHAM PHARMD

MEDICARE: JOHN RACKHAM PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPH60091763WA

General Provider Information

NPI Number : 1407180201
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN RACKHAM PHARMD
Provider Business Mailing Address
First Line : 1544 S BAILEY AVE
Second Line :
City : MOSES LAKE
State : WA
Zip : 98837-2146
Country : US
Telephone Number : 509-855-6161
Fax Number :
Provider Business Practice Location Address
First Line : 500 S PIONEER WAY
Second Line :
City : MOSES LAKE
State : WA
Zip : 98837-1812
Country : US
Telephone Number : 509-765-1219
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2009
Last Update Date : 09/25/2009

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