Provider Demographics
NPI:1134353485
Name:ERIC'S RX LLC
Entity type:Organization
Organization Name:ERIC'S RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:OST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-646-4800
Mailing Address - Street 1:810 WELSH RD
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-1011
Mailing Address - Country:US
Mailing Address - Phone:215-646-4800
Mailing Address - Fax:215-646-4885
Practice Address - Street 1:810 WELSH RD
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-1011
Practice Address - Country:US
Practice Address - Phone:215-646-4800
Practice Address - Fax:215-646-4885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-14
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RO00104600333600000X
FLPH280663336C0003X
PAPP4819363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1036223570001Medicaid
2120249OtherPK