1619035219 NPI number — RX IV INC

Table of content: (NPI 1619035219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619035219 NPI number — RX IV INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RX IV INC
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:
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:
1619035219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1938 WOODSLEE DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48083-2235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-435-9400
Provider Business Mailing Address Fax Number:
248-619-9624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1938 WOODSLEE DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48083-2235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-435-9400
Provider Business Practice Location Address Fax Number:
248-619-9624
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EALBA
Authorized Official First Name:
KEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
248-435-9400

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X , with the licence number:  5301005865 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: BR3638232 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336H0001X , with the licence number: 5301005865 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2351396 . This is a "BC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2921635 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 58512A . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5301005865 . This is a "MICHIGAN STATE PHARMACY ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2916690 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 540F307560 . This is a "BC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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