Provider Demographics
NPI:1255800132
Name:REXTOX CONSULTANT LLC
Entity type:Organization
Organization Name:REXTOX CONSULTANT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNSUSI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACY
Authorized Official - Phone:678-478-9511
Mailing Address - Street 1:2630 WELLINGTON WAY SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6413
Mailing Address - Country:US
Mailing Address - Phone:678-478-9511
Mailing Address - Fax:
Practice Address - Street 1:1810 HIGHWAY 20 SE STE 174
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2001
Practice Address - Country:US
Practice Address - Phone:678-478-9511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RETOX HEALING HANDS PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy