Provider Demographics
NPI:1033965751
Name:PROSXYSRX-LA LLC
Entity Type:Organization
Organization Name:PROSXYSRX-LA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:CALHOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-533-9119
Mailing Address - Street 1:1500 URBAN CENTER DR STE 325
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2205
Mailing Address - Country:US
Mailing Address - Phone:205-533-9119
Mailing Address - Fax:
Practice Address - Street 1:1731 LUTCHER AVE STE 1100
Practice Address - Street 2:
Practice Address - City:LUTCHER
Practice Address - State:LA
Practice Address - Zip Code:70071-5151
Practice Address - Country:US
Practice Address - Phone:225-327-1018
Practice Address - Fax:225-327-1019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPHY.008812.IROtherLABOP