Provider Demographics
NPI:1114017019
Name:EXPRESS MED PHARMACEUTICALS, INC.
Entity Type:Organization
Organization Name:EXPRESS MED PHARMACEUTICALS, INC.
Other - Org Name:SELECTRX PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARASCO
Authorized Official - Suffix:II
Authorized Official - Credentials:RPH
Authorized Official - Phone:877-837-9925
Mailing Address - Street 1:3950 BRODHEAD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-3030
Mailing Address - Country:US
Mailing Address - Phone:877-836-9925
Mailing Address - Fax:878-207-4516
Practice Address - Street 1:3950 BRODHEAD RD STE 100
Practice Address - Street 2:
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-3030
Practice Address - Country:US
Practice Address - Phone:877-836-9925
Practice Address - Fax:724-775-6495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
PAPP415385L3336L0003X, 3336M0002X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016866390002Medicaid
PA1237870001Medicare ID - Type Unspecified
PA0016866390002Medicaid