Provider Demographics
NPI:1245806785
Name:RACICKY, MELODIE D (PHARMACIST TECHNICIA)
Entity Type:Individual
Prefix:
First Name:MELODIE
Middle Name:D
Last Name:RACICKY
Suffix:
Gender:F
Credentials:PHARMACIST TECHNICIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 BASIN ST SW
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:WA
Mailing Address - Zip Code:98823-1852
Mailing Address - Country:US
Mailing Address - Phone:509-754-3513
Mailing Address - Fax:
Practice Address - Street 1:250 BASIN ST SW
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-1852
Practice Address - Country:US
Practice Address - Phone:509-754-3513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA61037827183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician