1659331726 NPI number — WRP, LLC

Table of content: (NPI 1659331726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659331726 NPI number — WRP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WRP, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659331726
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
916 W EVERGREEN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98660-3035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-213-2236
Provider Business Mailing Address Fax Number:
360-213-2238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
280 SW 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STEVENSON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-427-5480
Provider Business Practice Location Address Fax Number:
508-427-7807
Provider Enumeration Date:
03/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VEIS
Authorized Official First Name:
KRISTI
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF PHARMACY
Authorized Official Telephone Number:
503-507-6073

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  CF00056282 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4926739 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6021794 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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