Provider Demographics
NPI:1689241283
Name:SSRX LLC
Entity Type:Organization
Organization Name:SSRX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:FETCENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-660-8888
Mailing Address - Street 1:6330 WEST LOOP SOUTH
Mailing Address - Street 2:SUITE 700, 7TH FLOOR
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2928
Mailing Address - Country:US
Mailing Address - Phone:832-553-1385
Mailing Address - Fax:713-661-4828
Practice Address - Street 1:6330 WEST LOOP SOUTH
Practice Address - Street 2:SUITE 700 C
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2928
Practice Address - Country:US
Practice Address - Phone:832-553-1385
Practice Address - Fax:713-661-4828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy