Provider Demographics
NPI:1265830525
Name:RXB GROUP
Entity Type:Organization
Organization Name:RXB GROUP
Other - Org Name:DIAMOND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEFKADU
Authorized Official - Middle Name:
Authorized Official - Last Name:MENISTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-300-1148
Mailing Address - Street 1:2118 W DIAMOND ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-1410
Mailing Address - Country:US
Mailing Address - Phone:215-278-2284
Mailing Address - Fax:267-314-5835
Practice Address - Street 1:2118 W DIAMOND ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-1410
Practice Address - Country:US
Practice Address - Phone:215-278-2284
Practice Address - Fax:267-314-5835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4825313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2149389OtherPK