Provider Demographics
NPI:1760563720
Name:SAINT THOMAS RX LLC
Entity Type:Organization
Organization Name:SAINT THOMAS RX LLC
Other - Org Name:MODNURXPHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LLC MEMBER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:717-369-4636
Mailing Address - Street 1:4495 LINCOLN WAY W
Mailing Address - Street 2:
Mailing Address - City:SAINT THOMAS
Mailing Address - State:PA
Mailing Address - Zip Code:17252-9679
Mailing Address - Country:US
Mailing Address - Phone:717-369-4636
Mailing Address - Fax:717-369-5766
Practice Address - Street 1:4495 LINCOLN WAY W
Practice Address - Street 2:
Practice Address - City:SAINT THOMAS
Practice Address - State:PA
Practice Address - Zip Code:17252-9679
Practice Address - Country:US
Practice Address - Phone:717-369-4636
Practice Address - Fax:717-369-5766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
PAPP410754L3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145431OtherPK
PA7163550001Medicare NSC
2145431OtherPK
2084857OtherPK