Provider Demographics
NPI:1497984116
Name:HVVP RX LLC
Entity Type:Organization
Organization Name:HVVP RX LLC
Other - Org Name:PRIME RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIKAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GHIYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-398-1969
Mailing Address - Street 1:10720 PARK BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-5461
Mailing Address - Country:US
Mailing Address - Phone:727-398-1969
Mailing Address - Fax:
Practice Address - Street 1:10720 PARK BLVD STE E
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-5461
Practice Address - Country:US
Practice Address - Phone:727-398-1969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X, 3336C0004X, 3336S0011X
FLPH24141333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1046641OtherNCPDP PROVIDER IDENTIFICATION NUMBER