Provider Demographics
NPI:1902828932
Name:TIGERX PHARMACY INC
Entity Type:Organization
Organization Name:TIGERX PHARMACY INC
Other - Org Name:TIGERX PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:276-873-4700
Mailing Address - Street 1:PO BOX 1887
Mailing Address - Street 2:
Mailing Address - City:HONAKER
Mailing Address - State:VA
Mailing Address - Zip Code:24260-1887
Mailing Address - Country:US
Mailing Address - Phone:276-873-4700
Mailing Address - Fax:276-873-6091
Practice Address - Street 1:5638 REDBUD HIGHWAY
Practice Address - Street 2:
Practice Address - City:HONAKER
Practice Address - State:VA
Practice Address - Zip Code:24260
Practice Address - Country:US
Practice Address - Phone:276-873-4700
Practice Address - Fax:276-873-6091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0201003757333600000X
3336C0003X, 3336C0004X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2105213OtherPK
VA8502871Medicaid
2105213OtherPK