Provider Demographics
NPI:1467882779
Name:THRIVE RX SPECIALTY PHARMACY CORPORATION
Entity Type:Organization
Organization Name:THRIVE RX SPECIALTY PHARMACY CORPORATION
Other - Org Name:MYDREXA COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:858-726-2614
Mailing Address - Street 1:15644 POMERADO RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2400
Mailing Address - Country:US
Mailing Address - Phone:858-726-2614
Mailing Address - Fax:858-312-1130
Practice Address - Street 1:15644 POMERADO RD
Practice Address - Street 2:SUITE 303
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2400
Practice Address - Country:US
Practice Address - Phone:858-726-2614
Practice Address - Fax:858-312-1130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY51513333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy