Provider Demographics
NPI:1831610104
Name:PCA RX GROUP LLC
Entity type:Organization
Organization Name:PCA RX GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKUBOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-491-8178
Mailing Address - Street 1:9318 E COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-4100
Mailing Address - Country:US
Mailing Address - Phone:877-419-4459
Mailing Address - Fax:305-397-2527
Practice Address - Street 1:9318 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-4100
Practice Address - Country:US
Practice Address - Phone:877-419-4459
Practice Address - Fax:305-397-2527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier