Provider Demographics
NPI:1457017873
Name:FIRSTLINE RX LLC
Entity Type:Organization
Organization Name:FIRSTLINE RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMPOFO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-808-3089
Mailing Address - Street 1:2406 KARAT DR
Mailing Address - Street 2:SAN ANTONIO
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232
Mailing Address - Country:US
Mailing Address - Phone:918-808-3089
Mailing Address - Fax:
Practice Address - Street 1:2838 N LOOP 1604 E SUITE 108
Practice Address - Street 2:SAN ANTONIO
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1711
Practice Address - Country:US
Practice Address - Phone:210-481-4269
Practice Address - Fax:210-481-4270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy