Provider Demographics
NPI:1013336635
Name:DOCRX DISPENSE, INC.
Entity Type:Organization
Organization Name:DOCRX DISPENSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-367-5495
Mailing Address - Street 1:3544 E SOUTHERN AVE
Mailing Address - Street 2:NO. 104 UNIT 121
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5672
Mailing Address - Country:US
Mailing Address - Phone:480-367-5495
Mailing Address - Fax:480-367-5497
Practice Address - Street 1:3544 E SOUTHERN AVE
Practice Address - Street 2:NO. 104 UNIT 121
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5672
Practice Address - Country:US
Practice Address - Phone:480-367-5495
Practice Address - Fax:480-367-5497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site