Provider Demographics
NPI:1831417229
Name:RX PHARMACY
Entity type:Organization
Organization Name:RX PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-268-5153
Mailing Address - Street 1:13704 EUCLID AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-4220
Mailing Address - Country:US
Mailing Address - Phone:216-268-5153
Mailing Address - Fax:216-268-5157
Practice Address - Street 1:13704 EUCLID AVE STE 2
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-4220
Practice Address - Country:US
Practice Address - Phone:216-268-5153
Practice Address - Fax:216-268-5157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRTP0220089503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3679163OtherNCPDP PROVIDER IDENTIFICATION NUMBER