Provider Demographics
NPI:1740299460
Name:NRK RX INC
Entity type:Organization
Organization Name:NRK RX INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:734-323-1120
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48112
Mailing Address - Country:US
Mailing Address - Phone:734-241-2046
Mailing Address - Fax:888-310-3574
Practice Address - Street 1:211 N TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162
Practice Address - Country:US
Practice Address - Phone:734-241-2046
Practice Address - Fax:734-241-0857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301007810183500000X, 332B00000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2318536Medicaid
MI4625646Medicaid
MI5058610001Medicare NSC