Provider Demographics
NPI:1619411394
Name:RITA RX INC
Entity Type:Organization
Organization Name:RITA RX INC
Other - Org Name:DOUGLASVILLE DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-324-7054
Mailing Address - Street 1:3379 HIGHWAY 5
Mailing Address - Street 2:SUITE F
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-6928
Mailing Address - Country:US
Mailing Address - Phone:678-324-7054
Mailing Address - Fax:678-324-7838
Practice Address - Street 1:3379 HIGHWAY 5 STE F
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2377
Practice Address - Country:US
Practice Address - Phone:678-324-7054
Practice Address - Fax:678-324-7838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
GAPHRE0103253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166805OtherPK