Provider Demographics
NPI:1497858096
Name:PRX INC
Entity Type:Organization
Organization Name:PRX INC
Other - Org Name:PRX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:URTEAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-573-3314
Mailing Address - Street 1:5040 NW 7TH ST STE 470
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3489
Mailing Address - Country:US
Mailing Address - Phone:305-573-3314
Mailing Address - Fax:305-573-9669
Practice Address - Street 1:5040 NW 7TH ST STE 470
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3489
Practice Address - Country:US
Practice Address - Phone:305-573-3314
Practice Address - Fax:305-573-9669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH13731333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103400600Medicaid