Provider Demographics
NPI:1033247986
Name:DENTAL RX INC.
Entity Type:Organization
Organization Name:DENTAL RX INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:904-764-8280
Mailing Address - Street 1:1190 EDGEWOOD AVE W
Mailing Address - Street 2:SUITE B.
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-3419
Mailing Address - Country:US
Mailing Address - Phone:904-764-8280
Mailing Address - Fax:904-764-6625
Practice Address - Street 1:1190 EDGEWOOD AVE W
Practice Address - Street 2:SUITE B.
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-3419
Practice Address - Country:US
Practice Address - Phone:904-764-8280
Practice Address - Fax:904-764-6625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH21099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty