Provider Demographics
NPI:1780192104
Name:ESTRICK, RHETT DWAINE
Entity Type:Individual
Prefix:DR
First Name:RHETT
Middle Name:DWAINE
Last Name:ESTRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 S QUILLAN ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-2404
Mailing Address - Country:US
Mailing Address - Phone:509-586-1574
Mailing Address - Fax:509-585-1413
Practice Address - Street 1:2720 S QUILLAN ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337
Practice Address - Country:US
Practice Address - Phone:509-586-1574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR60483916390200000X
WAPH60860921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program