Provider Demographics
NPI:1013905678
Name:PROFESSIONAL RX INC
Entity Type:Organization
Organization Name:PROFESSIONAL RX INC
Other - Org Name:PROFESSIONAL PHARMACY WESTMINSTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO/CFO/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:T
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:714-893-2464
Mailing Address - Street 1:7361 WESTMINSTER BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-3990
Mailing Address - Country:US
Mailing Address - Phone:714-893-2464
Mailing Address - Fax:714-893-4255
Practice Address - Street 1:7631 WESTMINSTER BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3990
Practice Address - Country:US
Practice Address - Phone:714-893-2464
Practice Address - Fax:714-893-4255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1013905678Medicaid
CAPHY57949OtherBOARD OF PHARMACY