Provider Demographics
NPI:1558025890
Name:DOCTORS TELE PHARMACY OF WASHINGTON 01 LLC
Entity Type:Organization
Organization Name:DOCTORS TELE PHARMACY OF WASHINGTON 01 LLC
Other - Org Name:DOCTORS TELEPHARMACY OF WASHINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNAPPAREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-588-0000
Mailing Address - Street 1:1715 W KENNEWICK AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-3378
Mailing Address - Country:US
Mailing Address - Phone:509-417-0000
Mailing Address - Fax:509-651-5666
Practice Address - Street 1:1446 SPAULDING AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4720
Practice Address - Country:US
Practice Address - Phone:509-417-0000
Practice Address - Fax:509-651-5666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2022-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy