Provider Demographics
NPI:1871191064
Name:REX, TROY (RPH)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:REX
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12303 CORNERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:GRABILL
Mailing Address - State:IN
Mailing Address - Zip Code:46741-9504
Mailing Address - Country:US
Mailing Address - Phone:260-437-8639
Mailing Address - Fax:
Practice Address - Street 1:2100 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-1185
Practice Address - Country:US
Practice Address - Phone:260-824-0546
Practice Address - Fax:260-824-2378
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-11
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018318A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist