Provider Demographics
NPI:1356893507
Name:RXCOMPOUNDSTORE.COM LLC
Entity type:Organization
Organization Name:RXCOMPOUNDSTORE.COM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:YANKIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-793-3879
Mailing Address - Street 1:111 SW 3RD ST STE 302
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-1926
Mailing Address - Country:US
Mailing Address - Phone:844-793-3879
Mailing Address - Fax:844-875-0009
Practice Address - Street 1:111 SW 3RD ST STE 302
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130
Practice Address - Country:US
Practice Address - Phone:844-793-3879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH304123336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy