Provider Demographics
NPI:1659522738
Name:MR RX LLC
Entity Type:Organization
Organization Name:MR RX LLC
Other - Org Name:EXPRESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:MAHENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-936-9700
Mailing Address - Street 1:10549 N FLORIDA AVE
Mailing Address - Street 2:STE A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-6707
Mailing Address - Country:US
Mailing Address - Phone:813-936-9700
Mailing Address - Fax:813-936-9729
Practice Address - Street 1:10549 N FLORIDA AVE
Practice Address - Street 2:STE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-6707
Practice Address - Country:US
Practice Address - Phone:813-936-9700
Practice Address - Fax:813-936-9729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH235903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1038327OtherNCPDP PROVIDER IDENTIFICATION NUMBER