Provider Demographics
NPI:1063235653
Name:AVAIL RX LLC
Entity type:Organization
Organization Name:AVAIL RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:TIPPAWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NONTHANAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-292-3633
Mailing Address - Street 1:116 DEFENSE HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7040
Mailing Address - Country:US
Mailing Address - Phone:443-292-3633
Mailing Address - Fax:443-272-4733
Practice Address - Street 1:116 DEFENSE HWY STE 103
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7040
Practice Address - Country:US
Practice Address - Phone:443-292-3633
Practice Address - Fax:443-272-4733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy