Provider Demographics
NPI:1437550662
Name:GRANT RIVERSIDE PHY RXCARE
Entity Type:Organization
Organization Name:GRANT RIVERSIDE PHY RXCARE
Other - Org Name:RXCARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LEAD PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:614-566-3333
Mailing Address - Street 1:3595 OLENTANGY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3440
Mailing Address - Country:US
Mailing Address - Phone:614-566-3333
Mailing Address - Fax:614-566-1107
Practice Address - Street 1:3595 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3440
Practice Address - Country:US
Practice Address - Phone:614-566-3333
Practice Address - Fax:614-566-1107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH0210742003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2075820OtherPK