Provider Demographics
NPI:1013209204
Name:NOURISH RX, LLC
Entity Type:Organization
Organization Name:NOURISH RX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN
Authorized Official - Phone:978-473-1536
Mailing Address - Street 1:7 RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-5501
Mailing Address - Country:US
Mailing Address - Phone:978-473-1536
Mailing Address - Fax:866-921-9387
Practice Address - Street 1:7 RESERVOIR RD
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-5501
Practice Address - Country:US
Practice Address - Phone:978-473-1536
Practice Address - Fax:866-921-9387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3068133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty