Provider Demographics
NPI:1265871529
Name:PRIME RX LLC
Entity type:Organization
Organization Name:PRIME RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:H
Authorized Official - Last Name:ABDELMAKSOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-753-6873
Mailing Address - Street 1:10420 N MCKINLEY DR APT 11209
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-6450
Mailing Address - Country:US
Mailing Address - Phone:615-753-6873
Mailing Address - Fax:
Practice Address - Street 1:8486 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3808
Practice Address - Country:US
Practice Address - Phone:615-753-6873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy