Provider Demographics
NPI:1841610995
Name:EASY RX PAD, LLC
Entity Type:Organization
Organization Name:EASY RX PAD, LLC
Other - Org Name:DBA DELTA CARE RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-675-8672
Mailing Address - Street 1:264 SMITH TOWNSHIP STATE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BURGETTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15021-2124
Mailing Address - Country:US
Mailing Address - Phone:855-335-8219
Mailing Address - Fax:855-789-1959
Practice Address - Street 1:264 SMITH TOWNSHIP STATE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BURGETTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15021-2124
Practice Address - Country:US
Practice Address - Phone:855-335-8219
Practice Address - Fax:855-789-1959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherEIN