Provider Demographics
NPI:1497050454
Name:ASPIRE RX LLC
Entity Type:Organization
Organization Name:ASPIRE RX LLC
Other - Org Name:ST. LOUIS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-621-1534
Mailing Address - Street 1:121 E BROADWAY ST
Mailing Address - Street 2:STE. E
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2312
Mailing Address - Country:US
Mailing Address - Phone:989-773-4879
Mailing Address - Fax:989-773-5233
Practice Address - Street 1:116 N MILL ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MI
Practice Address - Zip Code:48880-1521
Practice Address - Country:US
Practice Address - Phone:989-681-6633
Practice Address - Fax:989-681-6644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010094993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2374899Medicaid
2374899OtherNCPDP PROVIDER IDENTIFICATION NUMBER