Tekoa RX LLC
Organization Active NPI Community/Retail Pharmacy · Tekoa, WA
NPI 1710046180 · NPPES record last updated Apr 24, 2019
Key facts
- NPI
- 1710046180
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PHAR.CF.00056426 (WA)
- Legal business name
- TEKOA RX LLC
- Practice address
- 124 N Crosby St
Tekoa, WA 99033 - Phone
- (509) 284-4205
- Fax
- (509) 284-3076
- NPI assigned
- Dec 8, 2006
- Organization subpart
- No
Authorized official
- Name
- Jessica Lorraine Sperber
- Title
- Owner/Manager
- Phone
- (509) 284-4205
Practitioners 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 50D2252122 | Tekoa Pharmacy | Certificate of waiver | Apr 4, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190524002469 | WA | Part B Supplier - Mass Immunization (Roster Biller Only) | 0244573756 | Practice locations: Tekoa, WA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PHAR.CF.00056426 | WA | Yes |
Addresses
Primary practice location
124 N Crosby St
Tekoa, WA 99033
Mailing address
PO Box 808
Tekoa, WA 99033
Phone (509) 284-4205
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2110562 | Other | PK | |
| 6022479 | Medicaid | WA |
Other names
- Tekoa Pharmacy
Other providers in Tekoa, WA
- Peter J. Martin
- Patricia L Primmer
- Tekoa Community Ambulance
- Tekoa Medical Foundation Inc
- Tekoa Operations LLC Tekoa Care Center
- Tekoa School District
All providers in Tekoa, WA · Community/Retail Pharmacy in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.