Provider Demographics
NPI:1982009981
Name:4URX
Entity Type:Organization
Organization Name:4URX
Other - Org Name:4URX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCHTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-225-4668
Mailing Address - Street 1:960 LANCASTER AVE
Mailing Address - Street 2:STE 2 REAR
Mailing Address - City:COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17512
Mailing Address - Country:US
Mailing Address - Phone:888-708-4879
Mailing Address - Fax:223-207-0450
Practice Address - Street 1:960 LANCASTER AVE
Practice Address - Street 2:STE 2 REAR
Practice Address - City:COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17512
Practice Address - Country:US
Practice Address - Phone:888-708-4879
Practice Address - Fax:223-207-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336M0002X
PAPP4824993336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148513OtherPK