Provider Demographics
NPI:1144230830
Name:RX EXPRESS PHARMACY , INC.
Entity Type:Organization
Organization Name:RX EXPRESS PHARMACY , INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:BARNARD
Authorized Official - Last Name:RAWLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-785-5386
Mailing Address - Street 1:6160 ARLINGTON AVE STE C14
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-1922
Mailing Address - Country:US
Mailing Address - Phone:951-785-5386
Mailing Address - Fax:951-785-0986
Practice Address - Street 1:6160 ARLINGTON AVE STE C14
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-1922
Practice Address - Country:US
Practice Address - Phone:951-785-5386
Practice Address - Fax:951-785-0986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA448720Medicaid
CAPHA448720Medicaid