Provider Demographics
NPI:1134393325
Name:RXSHOP, LLC
Entity type:Organization
Organization Name:RXSHOP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:270-597-2181
Mailing Address - Street 1:PO BOX 540
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42210-0540
Mailing Address - Country:US
Mailing Address - Phone:270-597-2181
Mailing Address - Fax:866-233-8342
Practice Address - Street 1:111 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:SMITHS GROVE
Practice Address - State:KY
Practice Address - Zip Code:42171
Practice Address - Country:US
Practice Address - Phone:270-563-2180
Practice Address - Fax:855-457-9282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP072493336C0003X
KYPO72493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2035132OtherPK
KY1266110002Medicare NSC
1830656OtherOTHER ID NUMBER