Provider Demographics
NPI:1114793353
Name:RXO COMMUNITY PHARMACY
Entity Type:Organization
Organization Name:RXO COMMUNITY PHARMACY
Other - Org Name:RXO COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHARMACY OFFICER - PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRANCO-MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:314-477-4532
Mailing Address - Street 1:10208 W FLORISSANT AVE
Mailing Address - Street 2:
Mailing Address - City:DELLWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63136-2106
Mailing Address - Country:US
Mailing Address - Phone:314-930-2185
Mailing Address - Fax:314-930-2186
Practice Address - Street 1:10208 W FLORISSANT AVE
Practice Address - Street 2:
Practice Address - City:DELLWOOD
Practice Address - State:MO
Practice Address - Zip Code:63136-2106
Practice Address - Country:US
Practice Address - Phone:314-930-2185
Practice Address - Fax:314-930-2186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-29
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy