Provider Demographics
NPI:1326045097
Name:RX SERVICES CORPORATION
Entity Type:Organization
Organization Name:RX SERVICES CORPORATION
Other - Org Name:EDISON PRESCRIPTION SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:239-561-2757
Mailing Address - Street 1:6799 HIGHLAND PINES CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-1378
Mailing Address - Country:US
Mailing Address - Phone:239-561-2757
Mailing Address - Fax:239-768-1292
Practice Address - Street 1:2665 CLEVELAND AVE
Practice Address - Street 2:#103
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-5850
Practice Address - Country:US
Practice Address - Phone:239-561-2757
Practice Address - Fax:239-768-1292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X, 3336C0004X
FLPH10783333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100617700Medicaid
FL100617701Medicaid
FL671486296Medicaid
1062861OtherOTHER ID NUMBER-COMMERCIAL NUMBER
1062861OtherOTHER ID NUMBER-COMMERCIAL NUMBER