Provider Demographics
NPI:1720530298
Name:PROXSYS RX - RUSH LLC
Entity Type:Organization
Organization Name:PROXSYS RX - RUSH LLC
Other - Org Name:THE PHARMACY AT THE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:CALHOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-533-9119
Mailing Address - Street 1:1500 URBAN CENTER DR STE 325
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2205
Mailing Address - Country:US
Mailing Address - Phone:205-533-9112
Mailing Address - Fax:205-918-7181
Practice Address - Street 1:206 MARION AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2706
Practice Address - Country:US
Practice Address - Phone:601-250-4400
Practice Address - Fax:601-250-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MS15009/1.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2165853OtherPK