Provider Demographics
NPI:1194141176
Name:EASY RX PAD, LLC
Entity type:Organization
Organization Name:EASY RX PAD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:724-414-1425
Mailing Address - Street 1:4249 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-3617
Mailing Address - Country:US
Mailing Address - Phone:855-335-8219
Mailing Address - Fax:855-789-1959
Practice Address - Street 1:264 SMITH TOWNSHIP STATE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:BURGETTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15021-2124
Practice Address - Country:US
Practice Address - Phone:855-335-8219
Practice Address - Fax:855-789-1959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy