1205043312 NPI number — CENTRAL RX INC

Table of content: (NPI 1205043312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205043312 NPI number — CENTRAL RX INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL RX 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:
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:
1205043312
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11536
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST THOMAS
Provider Business Mailing Address State Name:
VI
Provider Business Mailing Address Postal Code:
00801-4536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 CHARLOTTE AMALIE
Provider Second Line Business Practice Location Address:
TIME CENTER BUILDING
Provider Business Practice Location Address City Name:
ST THOMAS
Provider Business Practice Location Address State Name:
VI
Provider Business Practice Location Address Postal Code:
00801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
340-774-4033
Provider Business Practice Location Address Fax Number:
340-777-5478
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BENJAMIN
Authorized Official First Name:
ANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANG
Authorized Official Telephone Number:
340-775-0484

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  130481L , registered in the state of VI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2112051 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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