Provider Demographics
NPI:1992406292
Name:EDENRX PHARMACY LLC
Entity type:Organization
Organization Name:EDENRX PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TOLULOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHINBO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:907-444-5833
Mailing Address - Street 1:3819 HARBOR RD UNIT 104
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20732-3110
Mailing Address - Country:US
Mailing Address - Phone:443-906-3336
Mailing Address - Fax:443-964-5938
Practice Address - Street 1:3819 HARBOR RD UNIT 104
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE BEACH
Practice Address - State:MD
Practice Address - Zip Code:20732-3110
Practice Address - Country:US
Practice Address - Phone:443-906-3336
Practice Address - Fax:443-964-5938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-14
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy