Provider Demographics
NPI:1427619394
Name:RXCLINICLLC
Entity type:Organization
Organization Name:RXCLINICLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PHARMACIST, HIV PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WASIHUN
Authorized Official - Middle Name:BERHE
Authorized Official - Last Name:NICODIMOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, BCPS, BCMTMS
Authorized Official - Phone:505-402-7990
Mailing Address - Street 1:8700 GEORGIA AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-6600
Mailing Address - Country:US
Mailing Address - Phone:505-402-7990
Mailing Address - Fax:
Practice Address - Street 1:8700 GEORGIA AVE STE 403
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-6600
Practice Address - Country:US
Practice Address - Phone:505-402-7990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-21
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0002XSuppliersPharmacyClinic PharmacyGroup - Single Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty