Provider Demographics
NPI:1104838572
Name:REIDT PHARMACY CORPERATION
Entity Type:Organization
Organization Name:REIDT PHARMACY CORPERATION
Other - Org Name:HART AND DILATUSH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:REIDT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:509-624-2111
Mailing Address - Street 1:601 W RIVERSIDE AVE
Mailing Address - Street 2:STE. 140
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0621
Mailing Address - Country:US
Mailing Address - Phone:509-624-2111
Mailing Address - Fax:
Practice Address - Street 1:601 W RIVERSIDE AVE
Practice Address - Street 2:STE. 140
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0621
Practice Address - Country:US
Practice Address - Phone:509-624-2111
Practice Address - Fax:509-624-9500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF000583313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6028559Medicaid
WA5530540001Medicare NSC