Provider Demographics
NPI:1154859528
Name:PL RX PHARMACY INC
Entity Type:Organization
Organization Name:PL RX PHARMACY INC
Other - Org Name:PREMIER LIFE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-987-2351
Mailing Address - Street 1:9430 WARNER AVE STE G
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2826
Mailing Address - Country:US
Mailing Address - Phone:714-987-2351
Mailing Address - Fax:714-987-2357
Practice Address - Street 1:9430 WARNER AVE STE G
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2826
Practice Address - Country:US
Practice Address - Phone:714-987-2351
Practice Address - Fax:714-987-2357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY555333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy