Provider Demographics
NPI:1881052769
Name:CONTROLLED RX LLC
Entity type:Organization
Organization Name:CONTROLLED RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TASHIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-270-6748
Mailing Address - Street 1:4081 L B MCLEOD RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-5660
Mailing Address - Country:US
Mailing Address - Phone:407-270-6748
Mailing Address - Fax:855-274-0569
Practice Address - Street 1:4081 L B MCLEOD RD STE C
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-5660
Practice Address - Country:US
Practice Address - Phone:407-270-6748
Practice Address - Fax:855-274-0569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157964OtherPK