Provider Demographics
NPI:1790013159
Name:OCTAVIORX ENTERPRISES LLC
Entity Type:Organization
Organization Name:OCTAVIORX ENTERPRISES LLC
Other - Org Name:CHRISTIAN'S PHARMACY & MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:340-772-0093
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:FREDERIKSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00841-0485
Mailing Address - Country:US
Mailing Address - Phone:340-772-2234
Mailing Address - Fax:340-772-2236
Practice Address - Street 1:50 HANNAH'S REST
Practice Address - Street 2:
Practice Address - City:FREDERIKSTED
Practice Address - State:VI
Practice Address - Zip Code:00840
Practice Address - Country:US
Practice Address - Phone:340-772-0093
Practice Address - Fax:340-772-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VI241361L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5300467OtherNCPDP PROVIDER IDENTIFICATION NUMBER