Provider Demographics
NPI:1255331716
Name:INTRA RX DRUGS
Entity Type:Organization
Organization Name:INTRA RX DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BIANCA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-537-4431
Mailing Address - Street 1:809 E ROSECRANS AVE
Mailing Address - Street 2:
Mailing Address - City:EAST RANCHO DOMINGUEZ
Mailing Address - State:CA
Mailing Address - Zip Code:90221-2145
Mailing Address - Country:US
Mailing Address - Phone:310-537-4431
Mailing Address - Fax:310-537-8592
Practice Address - Street 1:809 E ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:EAST RANCHO DOMINGUEZ
Practice Address - State:CA
Practice Address - Zip Code:90221-2145
Practice Address - Country:US
Practice Address - Phone:310-537-4431
Practice Address - Fax:310-537-8592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-27
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 15308333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA153080Medicaid
CA0792180001Medicare NSC