Provider Demographics
NPI:1265466023
Name:RXTRA CARE HOME MEDICAL SUPPLY
Entity Type:Organization
Organization Name:RXTRA CARE HOME MEDICAL SUPPLY
Other - Org Name:U & I PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOLLIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:206-417-8066
Mailing Address - Street 1:7317 35TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115
Mailing Address - Country:US
Mailing Address - Phone:206-417-8066
Mailing Address - Fax:206-417-8076
Practice Address - Street 1:29 148TH AVE SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007
Practice Address - Country:US
Practice Address - Phone:425-747-3801
Practice Address - Fax:425-373-1786
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RXTRA CARE INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-10
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8029340Medicaid
WA0225720001Medicare UPIN
WA0225720001Medicare NSC