Provider Demographics
NPI:1093330482
Name:SURGE RX, LLC
Entity Type:Organization
Organization Name:SURGE RX, LLC
Other - Org Name:SURGE RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-741-1266
Mailing Address - Street 1:4320 BROADWAY ST STE 110
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-4016
Mailing Address - Country:US
Mailing Address - Phone:281-741-1266
Mailing Address - Fax:281-741-3151
Practice Address - Street 1:4320 BROADWAY ST STE 110
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-4016
Practice Address - Country:US
Practice Address - Phone:281-741-1266
Practice Address - Fax:281-741-3151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150289Medicaid