Provider Demographics
NPI:1669512109
Name:UNI CARE RX LLC
Entity Type:Organization
Organization Name:UNI CARE RX LLC
Other - Org Name:UNI CARE RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WORREL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:601-544-4848
Mailing Address - Street 1:124 WALNUT CIR
Mailing Address - Street 2:STE 1
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-3500
Mailing Address - Country:US
Mailing Address - Phone:601-544-4848
Mailing Address - Fax:601-544-4868
Practice Address - Street 1:124 WALNUT CIR
Practice Address - Street 2:STE 1
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-3500
Practice Address - Country:US
Practice Address - Phone:601-544-4848
Practice Address - Fax:601-544-4868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
MS037420233336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2045623OtherPK
MS00330325Medicaid
MS00330325Medicaid