1144230830 NPI number — RX EXPRESS PHARMACY , INC.

Table of content: DR. JOSEPH MATTHEW CROUSE DC (NPI 1023081270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144230830 NPI number — RX EXPRESS PHARMACY , INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RX EXPRESS PHARMACY , 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:
1144230830
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6160 ARLINGTON AVE STE C14
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92504-1922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-785-5386
Provider Business Mailing Address Fax Number:
951-785-0986

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6160 ARLINGTON AVE STE C14
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92504-1922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-785-5386
Provider Business Practice Location Address Fax Number:
951-785-0986
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAWLS
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
BARNARD
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
951-785-5386

Provider Taxonomy Codes

  • Taxonomy code: 183500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PHA448720 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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