Provider Demographics
NPI:1831194000
Name:WRX ENTERPRISES, INC.
Entity type:Organization
Organization Name:WRX ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:570-837-6285
Mailing Address - Street 1:239 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-1148
Mailing Address - Country:US
Mailing Address - Phone:570-837-6285
Mailing Address - Fax:570-837-6403
Practice Address - Street 1:239 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:PA
Practice Address - Zip Code:17842-1148
Practice Address - Country:US
Practice Address - Phone:570-837-6285
Practice Address - Fax:570-837-6403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP410437L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3936323OtherNCPDP #
PA4121880001Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
PA0018376440001Medicare ID - Type UnspecifiedMEDICARE PROVIDER #