1184355109 NPI number — RX AVE HEALTH LLC

Table of content: (NPI 1184355109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184355109 NPI number — RX AVE HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RX AVE HEALTH 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:
1184355109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2812 W. MLK JR BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-328-3970
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 N. WICKHAM ROAD
Provider Second Line Business Practice Location Address:
SUITE W
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-421-7620
Provider Business Practice Location Address Fax Number:
321-610-8920
Provider Enumeration Date:
06/21/2022

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
HARDIKKUMAR
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
973-362-6086

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 117201000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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