Provider Demographics
NPI:1538101001
Name:INDEPENDENT PHARMACIST RELIEF SERVICES
Entity Type:Organization
Organization Name:INDEPENDENT PHARMACIST RELIEF SERVICES
Other - Org Name:RITZVILLE DRUG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CORRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:509-659-0250
Mailing Address - Street 1:209 W MAIN AVE
Mailing Address - Street 2:P.O. BOX 43
Mailing Address - City:RITZVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99169-1409
Mailing Address - Country:US
Mailing Address - Phone:509-659-0250
Mailing Address - Fax:509-659-1763
Practice Address - Street 1:209 W MAIN AVE
Practice Address - Street 2:
Practice Address - City:RITZVILLE
Practice Address - State:WA
Practice Address - Zip Code:99169-1409
Practice Address - Country:US
Practice Address - Phone:509-659-0250
Practice Address - Fax:509-659-1763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
WAPHARCF000581973336C0003X
WACF00058197333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2107015OtherPK
WA6093603Medicaid
5902810001Medicare NSC