Provider Demographics
NPI:1376086587
Name:RESPACK LLC
Entity Type:Organization
Organization Name:RESPACK LLC
Other - Org Name:RESPACK LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:IKEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-330-3665
Mailing Address - Street 1:18110 SE 34TH ST STE 290
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9418
Mailing Address - Country:US
Mailing Address - Phone:800-330-3665
Mailing Address - Fax:800-982-2730
Practice Address - Street 1:18110 SE 34TH ST BLDG 2
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-9440
Practice Address - Country:US
Practice Address - Phone:800-330-3665
Practice Address - Fax:800-982-2730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-MOP-LIC-50122333600000X
ORRP-0003332-CS3336C0003X
WYNR-513093336L0003X
ID44154MS3336L0003X
WAPHAR.FC.60680723336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166391OtherPK