Provider Demographics
NPI:1578180758
Name:R.PH.S DIRECT PLLC
Entity Type:Organization
Organization Name:R.PH.S DIRECT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ELVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OSAGIE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:763-205-3928
Mailing Address - Street 1:7362 UNIVERSITY AVE NE STE 211
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-3151
Mailing Address - Country:US
Mailing Address - Phone:763-205-3928
Mailing Address - Fax:612-206-8284
Practice Address - Street 1:7362 UNIVERSITY AVE NE STE 211
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-3151
Practice Address - Country:US
Practice Address - Phone:763-205-3928
Practice Address - Fax:612-206-8284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy