Provider Demographics
NPI:1699925271
Name:AETNA RX HOME DELIVERY, LLC
Entity type:Organization
Organization Name:AETNA RX HOME DELIVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-273-9664
Mailing Address - Street 1:11500 NW AMBASSADOR DRIVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64153
Mailing Address - Country:US
Mailing Address - Phone:816-891-8019
Mailing Address - Fax:816-880-7200
Practice Address - Street 1:11500 NW AMBASSADOR DRIVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153
Practice Address - Country:US
Practice Address - Phone:816-891-8019
Practice Address - Fax:816-880-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080046153336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy