Provider Demographics
NPI:1780671941
Name:RXSHOP
Entity Type:Organization
Organization Name:RXSHOP
Other - Org Name:PRESCRIPTION SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:T
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-597-2181
Mailing Address - Street 1:1571 KY HIGHWAY 259 N
Mailing Address - Street 2:PO BOX 540
Mailing Address - City:BROWNSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42210-9206
Mailing Address - Country:US
Mailing Address - Phone:270-597-2181
Mailing Address - Fax:270-936-8602
Practice Address - Street 1:1571 KY HIGHWAY 259 N
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42210-9206
Practice Address - Country:US
Practice Address - Phone:270-597-2181
Practice Address - Fax:270-936-8602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP077323336C0003X
KYP064073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1803104OtherNCPDP NUMBER
KY90006669Medicaid
KY54034277Medicaid
KY1103810Medicaid
KY1266110001Medicare NSC