Provider Demographics
NPI:1043711088
Name:DIRECT RX PHARMACY INC
Entity Type:Organization
Organization Name:DIRECT RX PHARMACY INC
Other - Org Name:DIRECT RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:QUOC
Authorized Official - Middle Name:
Authorized Official - Last Name:HA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-200-6619
Mailing Address - Street 1:23275 S POINTE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1474
Mailing Address - Country:US
Mailing Address - Phone:949-281-7455
Mailing Address - Fax:949-276-3003
Practice Address - Street 1:23275 S POINTE DR STE 130
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1474
Practice Address - Country:US
Practice Address - Phone:949-281-7455
Practice Address - Fax:949-276-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-26
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336M0002X
CAPHY558583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176136OtherPK