Provider Demographics
NPI:1902181829
Name:15RX LLC
Entity Type:Organization
Organization Name:15RX LLC
Other - Org Name:15RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:DHIRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:AJMANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-684-1579
Mailing Address - Street 1:419 CARSON HL BLDG 1
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-5500
Mailing Address - Country:US
Mailing Address - Phone:210-684-1579
Mailing Address - Fax:210-684-1581
Practice Address - Street 1:11212 STATE HIGHWAY 151 STE 110
Practice Address - Street 2:PLAZA-2
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4500
Practice Address - Country:US
Practice Address - Phone:210-543-1579
Practice Address - Fax:210-543-1581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X, 3336C0004X
TX27839333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132135OtherPK