Provider Demographics
NPI:1235842162
Name:RX RENEWAL OF CALIFORNIA, PC
Entity Type:Organization
Organization Name:RX RENEWAL OF CALIFORNIA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, RX RENEWAL LLC
Authorized Official - Prefix:
Authorized Official - First Name:KELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-411-5694
Mailing Address - Street 1:261 W DATA DR
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-2372
Mailing Address - Country:US
Mailing Address - Phone:800-411-5694
Mailing Address - Fax:
Practice Address - Street 1:261 W DATA DR
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-2372
Practice Address - Country:US
Practice Address - Phone:800-411-5694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty