Provider Demographics
NPI:1457461238
Name:WARSAW RX LLC
Entity Type:Organization
Organization Name:WARSAW RX LLC
Other - Org Name:VALUE RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER-MANAGER/RPH
Authorized Official - Prefix:
Authorized Official - First Name:DALTON
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-522-0353
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-0427
Mailing Address - Country:US
Mailing Address - Phone:910-259-2116
Mailing Address - Fax:910-293-4397
Practice Address - Street 1:103 S DUDLEY ST
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-5539
Practice Address - Country:US
Practice Address - Phone:910-259-2116
Practice Address - Fax:910-259-7298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NC129393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158410OtherPK
NC0715201Medicaid