Provider Demographics
NPI:1154792570
Name:PRXP OF CA LLC
Entity type:Organization
Organization Name:PRXP OF CA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-477-7803
Mailing Address - Street 1:4345 E LOWELL ST
Mailing Address - Street 2:SUITES C & D
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-2222
Mailing Address - Country:US
Mailing Address - Phone:888-505-1485
Mailing Address - Fax:888-505-1485
Practice Address - Street 1:4345 E LOWELL ST
Practice Address - Street 2:SUITES C AND D
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-2222
Practice Address - Country:US
Practice Address - Phone:760-326-2312
Practice Address - Fax:760-326-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY557953336C0003X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2162397OtherPK