Provider Demographics
NPI:1114437985
Name:PHYSICIAN COMP RX, LLC
Entity Type:Organization
Organization Name:PHYSICIAN COMP RX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:BEATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-417-0938
Mailing Address - Street 1:540 E APPLEBY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4114
Mailing Address - Country:US
Mailing Address - Phone:800-417-0938
Mailing Address - Fax:844-892-9379
Practice Address - Street 1:540 E APPLEBY RD STE 104
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4114
Practice Address - Country:US
Practice Address - Phone:800-417-0938
Practice Address - Fax:844-892-9379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site