MEDICARE: PRIME RX, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy

General Provider Information

NPI Number	:	1215661582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME RX, INC.

Provider Business Mailing Address
First Line	:	5326 ATLANTIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5326 ATLANTIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805
Country	:	US
Telephone Number	:	562-786-6567
Fax Number	:

Authorized Official
Title or Position	:	CEO/CFO/SEC./DIR.
Name	:	DONALD HAN
Credential	:
Telephone Number	:	562-786-6567

Provider Enumeration Date	:	07/13/2022
Last Update Date	:	11/04/2022

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Directions to “PRIME RX, INC. ” Practice Location

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