MEDICARE: COLUMBIA RIVER PHARMACY

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
1	333600000X	Pharmacy
2	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PHAR.CF.60176819	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2106368	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861423717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBIA RIVER PHARMACY

Provider Business Mailing Address
First Line	:	1906 GEORGE WASHINGTON WAY
Second Line	:
City	:	RICHLAND
State	:	WA
Zip	:	99354-2308
Country	:	US
Telephone Number	:	509-943-9173
Fax Number	:	509-946-1122

Provider Business Practice Location Address
First Line	:	1906 GEORGE WASHINGTON WAY
Second Line	:
City	:	RICHLAND
State	:	WA
Zip	:	99354-2308
Country	:	US
Telephone Number	:	509-943-9173
Fax Number	:	509-946-1122

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES HENRIKSEN
Credential	:	PHARMD
Telephone Number	:	509-943-9173

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	01/15/2016

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Directions to “COLUMBIA RIVER PHARMACY ” Practice Location

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