Provider Demographics
NPI:1619035219
Name:RX IV INC
Entity Type:Organization
Organization Name:RX IV INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EALBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-435-9400
Mailing Address - Street 1:1938 WOODSLEE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2235
Mailing Address - Country:US
Mailing Address - Phone:248-435-9400
Mailing Address - Fax:248-619-9624
Practice Address - Street 1:1938 WOODSLEE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2235
Practice Address - Country:US
Practice Address - Phone:248-435-9400
Practice Address - Fax:248-619-9624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301005865251F00000X, 3336H0001X
MI332B00000X
MIBR36382323336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2351396OtherBC
MI2921635Medicaid
MI58512AOtherHAP
MI5301005865OtherMICHIGAN STATE PHARMACY ID
MI2916690Medicaid
MI540F307560OtherBC
MI540F307560OtherBC
MI2916690Medicaid