Provider Demographics
NPI:1275098709
Name:EMPIRESRX
Entity Type:Organization
Organization Name:EMPIRESRX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DINESH
Authorized Official - Middle Name:
Authorized Official - Last Name:GAJJALA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:509-631-1453
Mailing Address - Street 1:PO BOX 871
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-0871
Mailing Address - Country:US
Mailing Address - Phone:509-631-1453
Mailing Address - Fax:
Practice Address - Street 1:315 S. WHITCOMB AVE
Practice Address - Street 2:
Practice Address - City:TONASKET
Practice Address - State:WA
Practice Address - Zip Code:98855
Practice Address - Country:US
Practice Address - Phone:509-486-0123
Practice Address - Fax:509-486-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy