Provider Demographics
NPI:1821569633
Name:HEALTHRX PHARMACY, LLC.
Entity Type:Organization
Organization Name:HEALTHRX PHARMACY, LLC.
Other - Org Name:HEALTHRX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-461-5131
Mailing Address - Street 1:PO BOX 1163
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77487-1163
Mailing Address - Country:US
Mailing Address - Phone:832-461-5131
Mailing Address - Fax:
Practice Address - Street 1:727 E BETHANY HOME RD STE B110
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2151
Practice Address - Country:US
Practice Address - Phone:480-350-7550
Practice Address - Fax:480-350-7781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ476189Medicaid