Provider Demographics
NPI:1134494636
Name:REPP, DAVID P (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:P
Last Name:REPP
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-4900
Mailing Address - Country:US
Mailing Address - Phone:509-332-0503
Mailing Address - Fax:509-332-0233
Practice Address - Street 1:1450 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-4900
Practice Address - Country:US
Practice Address - Phone:509-332-0503
Practice Address - Fax:509-332-0233
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00007627183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist