Provider Demographics
NPI:1518064906
Name:RX MEDEQ LLC
Entity Type:Organization
Organization Name:RX MEDEQ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ITALO
Authorized Official - Middle Name:
Authorized Official - Last Name:ZANOLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:PHCY TECH
Authorized Official - Phone:910-285-6114
Mailing Address - Street 1:5642 NC HWY 41 SOUTH
Mailing Address - Street 2:
Mailing Address - City:WALLACE
Mailing Address - State:NC
Mailing Address - Zip Code:28458
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5642 NC HWY 41 SOUTH
Practice Address - Street 2:
Practice Address - City:WALLACE
Practice Address - State:NC
Practice Address - Zip Code:28458
Practice Address - Country:US
Practice Address - Phone:910-285-6114
Practice Address - Fax:910-552-2078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC093983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3440017OtherOTHER ID NUMBER
NC0315467Medicaid