Provider Demographics
NPI:1609890060
Name:RXDIRECT, INC.
Entity Type:Organization
Organization Name:RXDIRECT, INC.
Other - Org Name:OLSON INSTITUTIONAL PHARMACY SERVICES-DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:T
Authorized Official - Last Name:NG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:503-657-9422
Mailing Address - Street 1:16246 SE MCLOUGHLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-4657
Mailing Address - Country:US
Mailing Address - Phone:503-657-9422
Mailing Address - Fax:503-656-0278
Practice Address - Street 1:16246 SE MCLOUGHLIN BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-4657
Practice Address - Country:US
Practice Address - Phone:503-657-9422
Practice Address - Fax:503-656-0278
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RX DIRECT, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORIP-0001408-CS332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR005770Medicaid
OR116790Medicare PIN
OR005770Medicaid