Provider Demographics
NPI:1710225008
Name:PHYSICIANS RX PHARMACY LLC
Entity Type:Organization
Organization Name:PHYSICIANS RX PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-477-7803
Mailing Address - Street 1:9701 APOLLO DR STE 400
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-4791
Mailing Address - Country:US
Mailing Address - Phone:301-477-3367
Mailing Address - Fax:866-354-1868
Practice Address - Street 1:9701 APOLLO DR STE 400
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-4791
Practice Address - Country:US
Practice Address - Phone:301-477-3367
Practice Address - Fax:866-354-1868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL054.018661333600000X
MDP063663336C0003X
DCNRX00004503336C0003X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2139016OtherPK
MD549920800Medicaid
DC59780800Medicaid
IL465033443001Medicaid