Provider Demographics
NPI:1386067007
Name:MEDRX SPECIALTY PHARMACY, LLC.
Entity type:Organization
Organization Name:MEDRX SPECIALTY PHARMACY, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERMAINE
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-303-3189
Mailing Address - Street 1:P.O. BOX 2188
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77410
Mailing Address - Country:US
Mailing Address - Phone:713-303-3189
Mailing Address - Fax:855-848-1141
Practice Address - Street 1:4726 E TEXAS ST
Practice Address - Street 2:SUITE 230
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2545
Practice Address - Country:US
Practice Address - Phone:855-825-5014
Practice Address - Fax:855-848-1141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPHY.68283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy