1578987814 NPI number — MSRX INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578987814 NPI number — MSRX INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MSRX 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:
AUSTIN COMMUNITY COMPOUNDING PHARMACY
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:
1578987814
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6025 JEAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE OSWEGO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97035-5307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-704-1485
Provider Business Mailing Address Fax Number:
503-344-4994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 01 AUSTIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-459-0090
Provider Business Practice Location Address Fax Number:
718-459-8090
Provider Enumeration Date:
02/06/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSEN
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
503-704-1485

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X , with the licence number:  32632 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2146833 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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