Provider Demographics
NPI:1265897664
Name:MILLENNIUM RX, LLC
Entity type:Organization
Organization Name:MILLENNIUM RX, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:VALORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GINGRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-346-7600
Mailing Address - Street 1:12560 REED RD STE 350
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3380
Mailing Address - Country:US
Mailing Address - Phone:855-346-7600
Mailing Address - Fax:855-346-7800
Practice Address - Street 1:12560 REED RD STE 350
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3380
Practice Address - Country:US
Practice Address - Phone:855-346-7600
Practice Address - Fax:855-346-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X
TX30403333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2156175OtherPK