1881864494 NPI number — CSRX, INC.

Table of content: (NPI 1881864494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881864494 NPI number — CSRX, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CSRX, 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:
MEDICINE SHOPPE ADVANCED CARE 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:
1881864494
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1304 MOUNT RUSHMORE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAPID CITY
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57701-3667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-348-2500
Provider Business Mailing Address Fax Number:
605-348-2622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5626 FARGO LANE
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
RAPID CITY
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57701-4645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-348-2500
Provider Business Practice Location Address Fax Number:
605-348-2622
Provider Enumeration Date:
03/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RISING
Authorized Official First Name:
CURTIS
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER PHARMACIST
Authorized Official Telephone Number:
605-348-2500

Provider Taxonomy Codes

  • Taxonomy code: 3336L0003X , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 138349 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21503 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8504500 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9162840 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4354091 . This is a "NCPDP" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com