Provider Demographics
NPI:1073588380
Name:RX EXPRESS PHARMACY OF NAVARRE INC
Entity Type:Organization
Organization Name:RX EXPRESS PHARMACY OF NAVARRE INC
Other - Org Name:RX EXPRESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMELLEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:850-936-6446
Mailing Address - Street 1:PO BOX 6244
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-1844
Mailing Address - Country:US
Mailing Address - Phone:850-936-6446
Mailing Address - Fax:850-936-6314
Practice Address - Street 1:8986 ORTEGA PARK DR
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-4141
Practice Address - Country:US
Practice Address - Phone:850-936-6446
Practice Address - Fax:850-936-6314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH18588333600000X
3336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025532700Medicaid
1095834OtherNCPDP PROVIDER IDENTIFICATION NUMBER
4575430001Medicare NSC