Healthcare Provider Details

I. General information

NPI: 1154792570
Provider Name (Legal Business Name): PRXP OF CA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4345 E LOWELL ST SUITES C AND D
ONTARIO CA
91761-2222
US

IV. Provider business mailing address

4345 E LOWELL ST SUITES C & D
ONTARIO CA
91761-2222
US

V. Phone/Fax

Practice location:
  • Phone: 760-326-2312
  • Fax: 760-326-4178
Mailing address:
  • Phone: 888-505-1485
  • Fax: 888-505-1485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY55795
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHRIS WAKEFIELD
Title or Position: CORPORATE MANAGER
Credential:
Phone: 412-477-7803