Provider Demographics
NPI:1902067770
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 1:125 S COWLEY ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1500
Mailing Address - Country:US
Mailing Address - Phone:509-343-3400
Mailing Address - Fax:509-370-7323
Practice Address - Street 1:125 S COWLEY ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1500
Practice Address - Country:US
Practice Address - Phone:509-343-3400
Practice Address - Fax:509-370-7323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMTS-5217291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50D1079339OtherWASHINGTON STATE DEPARTMENT OF HEALTH MEDICAL TEST SITE LICENSE