Provider Demographics
NPI:1427519842
Name:ACCESS MYRX PHARMACY LLC
Entity type:Organization
Organization Name:ACCESS MYRX PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-509-9834
Mailing Address - Street 1:9632 EMERALD OAK DR STE G
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2258
Mailing Address - Country:US
Mailing Address - Phone:916-479-0615
Mailing Address - Fax:
Practice Address - Street 1:9632 EMERALD OAK DR STE G
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2258
Practice Address - Country:US
Practice Address - Phone:916-479-0615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACCESS MYRX PHARMACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-28
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy