PHYSICANS RX PHARMACY OF CLINTON INC

Provider Demographics

• NPI: 1134543440
• Name: PHYSICANS RX PHARMACY OF CLINTON INC
• Entity type: Organization
• Organization Name: PHYSICANS RX PHARMACY OF CLINTON INC
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - First Name: CHRIS
• Authorized Official - Last Name: WAKEFIELD
• Authorized Official - Phone: 412-477-7803
• Mailing Address - Street 1: 1193 BEECHWOOD BLVD
• Mailing Address - City: PITTSBURGH
• Mailing Address - State: PA
• Mailing Address - Zip Code: 15206-4545
• Mailing Address - Country: US
• Mailing Address - Phone: 412-357-5163
• Mailing Address - Fax: 412-357-5163
• Practice Address - Street 1: 9131 PISCATAWAY RD STE 670
• Practice Address - City: CLINTON
• Practice Address - State: MD
• Practice Address - Zip Code: 20735-2579
• Practice Address - Country: US
• Practice Address - Phone: 240-348-7157
• Practice Address - Fax: 240-348-7160
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2014-02-06
• Last Update Date: 2023-07-19

Provider Licenses

State	License ID	Taxonomies
FL	PH29263	333600000X, 333600000X
MD	P06365	3336C0003X, 3336C0003X
NY	033410	3336C0003X
NC	12391	3336C0003X
WA	PHNR.FO.60558826	3336C0003X
GA	PHNR000820	3336C0003X
PA	NP000126	3336C0003X, 3336C0003X
DC	NRX0000486	3336C0003X, 3336C0003X
OH	022443300	3336C0003X
NJ	28RO00107800	3336C0003X
MO	2015044565	3336C0003X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	3336C0003X	Suppliers	Pharmacy	Community/Retail Pharmacy
No	333600000X	Suppliers	Pharmacy

Provider Identifiers

State	Identifier ID	ID Type	Issuer
WA	2047646	Medicaid
MD	545850100	Medicaid
	2144208	Other	PK
DC	055238200	Medicaid
DC	055238200	Medicaid
VA	1134543440	Medicaid
	2144208	Other	PK
DC	055238200	Medicaid