Provider Demographics
NPI:1528566981
Name:RXLTC, PLLC
Entity Type:Organization
Organization Name:RXLTC, PLLC
Other - Org Name:RX PHARMACY LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:509-713-7444
Mailing Address - Street 1:969 STEVENS DR STE 1B
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3557
Mailing Address - Country:US
Mailing Address - Phone:509-940-9001
Mailing Address - Fax:509-940-9002
Practice Address - Street 1:8021 W GRANDRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7146
Practice Address - Country:US
Practice Address - Phone:509-940-9001
Practice Address - Fax:509-940-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-31
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA604-190-004OtherUBI
WAPHAR.CF.61133843OtherSTATE LICENSE