Provider Demographics
NPI:1518052612
Name:REX PHARMACY INC.
Entity Type:Organization
Organization Name:REX PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-243-2110
Mailing Address - Street 1:1607 E. 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022
Mailing Address - Country:US
Mailing Address - Phone:712-243-2110
Mailing Address - Fax:712-243-2064
Practice Address - Street 1:317 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:IA
Practice Address - Zip Code:51455
Practice Address - Country:US
Practice Address - Phone:712-655-2665
Practice Address - Fax:712-655-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
IA163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA140000941OtherMEDCOHEALTH ACCOUNT ID#
IA1615511OtherNCPDP/NABP IDENTIFYER
IA0050831Medicaid
IA0390160001Medicare NSC