Provider Demographics
NPI:1104192335
Name:RX PRO PHARMACY & COMPOUNDING, INC
Entity Type:Organization
Organization Name:RX PRO PHARMACY & COMPOUNDING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RUTLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-455-0004
Mailing Address - Street 1:932 W HALLANDALE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5241
Mailing Address - Country:US
Mailing Address - Phone:954-455-0004
Mailing Address - Fax:601-982-7103
Practice Address - Street 1:932 W HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5241
Practice Address - Country:US
Practice Address - Phone:954-455-0004
Practice Address - Fax:601-982-7103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH260113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy