Provider Demographics
NPI:1942312855
Name:PRESCRIPTION PHARMACY
Entity Type:Organization
Organization Name:PRESCRIPTION PHARMACY
Other - Org Name:PRESCRIPTION PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-943-9121
Mailing Address - Street 1:1334 JADWIN AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-3404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 SWIFT BLVD STE 160
Practice Address - Street 2:STE 160
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3559
Practice Address - Country:US
Practice Address - Phone:509-943-9121
Practice Address - Fax:509-946-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WA2620103053403336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6116800Medicaid
4900177OtherNCPDP PROVIDER IDENTIFICATION NUMBER