Provider Demographics
NPI:1063976777
Name:HIYA RX, LLC
Entity type:Organization
Organization Name:HIYA RX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:PUSHPAKKUMAR
Authorized Official - Middle Name:D
Authorized Official - Last Name:RAVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-804-0817
Mailing Address - Street 1:1140 E VAN FLEET DR
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-7626
Mailing Address - Country:US
Mailing Address - Phone:352-804-0817
Mailing Address - Fax:
Practice Address - Street 1:1140 E VAN FLEET DR
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-7626
Practice Address - Country:US
Practice Address - Phone:352-804-0817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-27
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy