Provider Demographics
NPI:1437818291
Name:PRIME RX CONSULTANT SERVICES INC
Entity Type:Organization
Organization Name:PRIME RX CONSULTANT SERVICES INC
Other - Org Name:RIVERDALE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLAWALE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLAGBENDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-576-1428
Mailing Address - Street 1:2712 BLUESTONE DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-9531
Mailing Address - Country:US
Mailing Address - Phone:678-489-8484
Mailing Address - Fax:678-802-6261
Practice Address - Street 1:6545A CHURCH ST
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2185
Practice Address - Country:US
Practice Address - Phone:678-489-8484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-09
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy