1326045097 NPI number — RX SERVICES CORPORATION

Table of content: (NPI 1326045097)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326045097 NPI number — RX SERVICES CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RX SERVICES CORPORATION
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:
EDISON PRESCRIPTION SHOPPE
Provider Other Organization Name Type Code:
3
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:
1326045097
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6799 HIGHLAND PINES CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33966-1378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-561-2757
Provider Business Mailing Address Fax Number:
239-768-1292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2665 CLEVELAND AVE
Provider Second Line Business Practice Location Address:
#103
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33901-5850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-561-2757
Provider Business Practice Location Address Fax Number:
239-768-1292
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JACOBS
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT PHARMACIST
Authorized Official Telephone Number:
239-561-2757

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: PH10783 , registered in the state of FL ; 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" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100617700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100617701 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 671486296 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1062861 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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