Provider Demographics
NPI:1043347933
Name:RXTRA CARE, INC.
Entity type:Organization
Organization Name:RXTRA CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:206-938-6196
Mailing Address - Street 1:4831 35TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-2709
Mailing Address - Country:US
Mailing Address - Phone:206-938-6196
Mailing Address - Fax:206-938-6197
Practice Address - Street 1:4831 35TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-2709
Practice Address - Country:US
Practice Address - Phone:206-938-6196
Practice Address - Fax:206-938-6197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4930625OtherNCPDP
WA6027221Medicaid
BR8613552OtherDEA