Provider Demographics
NPI:1629303714
Name:PHARMXPRESS LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:PHARMXPRESS LIMITED LIABILITY COMPANY
Other - Org Name:PHARMXPRESS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BUNNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-406-4491
Mailing Address - Street 1:507 E DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3932
Mailing Address - Country:US
Mailing Address - Phone:813-406-4491
Mailing Address - Fax:813-279-6266
Practice Address - Street 1:507 E DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:STE 101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3932
Practice Address - Country:US
Practice Address - Phone:813-406-4491
Practice Address - Fax:813-279-6266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FLPH24350333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002521500Medicaid
2123313OtherPK
FL002521501Medicaid