Provider Demographics
NPI:1669544458
Name:RIX PHARMACY PA
Entity type:Organization
Organization Name:RIX PHARMACY PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:320-760-8471
Mailing Address - Street 1:PO BOX 295
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-0295
Mailing Address - Country:US
Mailing Address - Phone:320-763-3146
Mailing Address - Fax:320-763-7231
Practice Address - Street 1:1525 BROADWAY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-3007
Practice Address - Country:US
Practice Address - Phone:320-763-3146
Practice Address - Fax:320-763-7231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X, 333600000X
MN2620923336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN694757300Medicaid
2412788OtherNCPDP PROVIDER IDENTIFICATION NUMBER
5284290001Medicare NSC