Provider Demographics
NPI:1184001935
Name:RELIANT RX, LLC
Entity type:Organization
Organization Name:RELIANT RX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KROETCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-343-3400
Mailing Address - Street 1:2820 N ASTOR ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-2112
Mailing Address - Country:US
Mailing Address - Phone:509-343-3400
Mailing Address - Fax:509-340-7323
Practice Address - Street 1:767 WILLIAMS BLVD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99354-3221
Practice Address - Country:US
Practice Address - Phone:866-440-5457
Practice Address - Fax:844-340-7322
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RELIANT RX, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-30
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPHAR.CF.60558051333600000X, 3336C0002X, 3336C0003X, 3336C0004X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2045307Medicaid
WA6014540002Medicare NSC