Provider Demographics
NPI:1437312964
Name:RAXO DRUG INC
Entity Type:Organization
Organization Name:RAXO DRUG INC
Other - Org Name:RAXO DRUGS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARAF
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSEEBULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-219-0866
Mailing Address - Street 1:3199 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3308
Mailing Address - Country:US
Mailing Address - Phone:702-369-9135
Mailing Address - Fax:702-369-6920
Practice Address - Street 1:3199 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3308
Practice Address - Country:US
Practice Address - Phone:702-369-9135
Practice Address - Fax:702-369-6920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NVPH010343336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2050823OtherPK