Provider Demographics
NPI:1821695735
Name:MSM RX LLC
Entity Type:Organization
Organization Name:MSM RX LLC
Other - Org Name:VISTARA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RAJDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:813-667-6075
Mailing Address - Street 1:6323B N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-4733
Mailing Address - Country:US
Mailing Address - Phone:803-766-6075
Mailing Address - Fax:803-766-6076
Practice Address - Street 1:6323B N MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-4733
Practice Address - Country:US
Practice Address - Phone:803-766-6075
Practice Address - Fax:803-766-6076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-04
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy