Provider Demographics
NPI:1053712554
Name:RX ANTE PHARMACY SERVICES, LLC
Entity type:Organization
Organization Name:RX ANTE PHARMACY SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP/GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:202-507-2071
Mailing Address - Street 1:45999 CENTER OAK PLZ STE 120
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-6586
Mailing Address - Country:US
Mailing Address - Phone:703-444-4365
Mailing Address - Fax:703-444-4687
Practice Address - Street 1:45999 CENTER OAK PLZ STE 120
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-6586
Practice Address - Country:US
Practice Address - Phone:703-444-4365
Practice Address - Fax:703-444-4687
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RX ANTE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-16
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010045943336L0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1038904830001Medicaid
VA1053712554Medicaid
2147924OtherPK