Provider Demographics
NPI:1922106954
Name:MEDI RX CORP
Entity Type:Organization
Organization Name:MEDI RX CORP
Other - Org Name:MEDI RX PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-757-8555
Mailing Address - Street 1:6401 OLDE STONE XING
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-4203
Mailing Address - Country:US
Mailing Address - Phone:330-757-8555
Mailing Address - Fax:330-757-8550
Practice Address - Street 1:6401 OLDE STONE XING
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-4203
Practice Address - Country:US
Practice Address - Phone:330-757-8555
Practice Address - Fax:330-757-8550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0206971003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001520749003Medicaid
OH0872828Medicaid
2072424OtherPK
1079850001Medicare NSC