Provider Demographics
NPI:1083865463
Name:RADIUS RX DIRECT INC
Entity Type:Organization
Organization Name:RADIUS RX DIRECT INC
Other - Org Name:RADIUS RX DIRECT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:EWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-658-9196
Mailing Address - Street 1:PO BOX 1159
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19899-1159
Mailing Address - Country:US
Mailing Address - Phone:302-658-9196
Mailing Address - Fax:302-658-8495
Practice Address - Street 1:501 N SHIPLEY ST
Practice Address - Street 2:UNIT 2
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-2226
Practice Address - Country:US
Practice Address - Phone:302-658-9196
Practice Address - Fax:302-658-8495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-03
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
DEA300008963336L0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1083865463Medicaid
2118191OtherPK