Healthcare Provider Details

I. General information

NPI: 1720116122
Provider Name (Legal Business Name): RX TRADER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2256 COLORADO BLVD SUITES 107 & 108
EAGLE ROCK CA
90041-1164
US

IV. Provider business mailing address

2256 COLORADO BLVD SUITES 107 & 108
EAGLE ROCK CA
90041-1164
US

V. Phone/Fax

Practice location:
  • Phone: 323-551-5906
  • Fax: 323-551-5908
Mailing address:
  • Phone: 323-551-5906
  • Fax: 323-551-5908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number51609
License Number StateCA

VIII. Authorized Official

Name: CURTIS HAGUE
Title or Position: OWENR
Credential:
Phone: 323-551-5906