Provider Demographics
NPI:1093995417
Name:DAVITA RX, LLC
Entity Type:Organization
Organization Name:DAVITA RX, LLC
Other - Org Name:DAVITA RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-876-2857
Mailing Address - Street 1:1234 LAKESHORE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4980
Mailing Address - Country:US
Mailing Address - Phone:901-867-5357
Mailing Address - Fax:866-208-4462
Practice Address - Street 1:1234 LAKESHORE DR STE 200
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4980
Practice Address - Country:US
Practice Address - Phone:901-867-5357
Practice Address - Fax:866-208-4462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy