Provider Demographics
NPI:1467879064
Name:RXADVANCE
Entity Type:Organization
Organization Name:RXADVANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:IKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-804-6900
Mailing Address - Street 1:2 PARK CENTRAL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-1777
Mailing Address - Country:US
Mailing Address - Phone:508-804-6900
Mailing Address - Fax:
Practice Address - Street 1:2 PARK CENTRAL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01772-1777
Practice Address - Country:US
Practice Address - Phone:508-804-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service