Provider Demographics
NPI:1508053075
Name:RX INSTITUTIONAL SERVICES LLC
Entity Type:Organization
Organization Name:RX INSTITUTIONAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCDERMOTT
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:724-699-7328
Mailing Address - Street 1:8571 FOXWOOD CT STE A
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-4313
Mailing Address - Country:US
Mailing Address - Phone:330-318-3926
Mailing Address - Fax:330-318-3927
Practice Address - Street 1:1419 BOARDMAN CANFIELD RD STE 340
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512
Practice Address - Country:US
Practice Address - Phone:330-505-1979
Practice Address - Fax:330-505-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH02-17260503336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH02-1726050OtherSTATE OF OHIO
OH2769759Medicaid