Provider Demographics
NPI:1518213073
Name:DOCRX DISPENSE, INC
Entity Type:Organization
Organization Name:DOCRX DISPENSE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:V
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-367-5495
Mailing Address - Street 1:3544 E SOUTHERN AVE
Mailing Address - Street 2:NO. 104-121
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5672
Mailing Address - Country:US
Mailing Address - Phone:480-367-5495
Mailing Address - Fax:
Practice Address - Street 1:3544 E SOUTHERN AVE
Practice Address - Street 2:NO. 104-121
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5672
Practice Address - Country:US
Practice Address - Phone:480-367-5495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy