Provider Demographics
NPI:1477900033
Name:WORK INJURY RX ONE LLC
Entity Type:Organization
Organization Name:WORK INJURY RX ONE LLC
Other - Org Name:WIRX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-471-1025
Mailing Address - Street 1:142 S 52ND ST STE 202
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-3409
Mailing Address - Country:US
Mailing Address - Phone:215-471-1025
Mailing Address - Fax:215-471-1026
Practice Address - Street 1:142 S 52ND ST STE 202
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19139-3409
Practice Address - Country:US
Practice Address - Phone:215-471-1025
Practice Address - Fax:215-471-1026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy