Provider Demographics
NPI:1164529095
Name:PADRA CORPORATION
Entity Type:Organization
Organization Name:PADRA CORPORATION
Other - Org Name:RX EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SUTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-836-3352
Mailing Address - Street 1:1115 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:21034-1405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1115 MAIN ST
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:MD
Practice Address - Zip Code:21034-1405
Practice Address - Country:US
Practice Address - Phone:410-457-5521
Practice Address - Fax:410-457-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP015983336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127000OtherOTHER ID NUMBER
2127000OtherOTHER ID NUMBER-COMMERCIAL NUMBER