Healthcare Provider Details

I. General information

NPI: 1104665173
Provider Name (Legal Business Name): PRXP OF CA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

1193 BEECHWOOD BLVD
PITTSBURGH PA
15206-4545
US

V. Phone/Fax

Practice location:
  • Phone: 888-505-1485
  • Fax: 888-505-1485
Mailing address:
  • Phone: 412-477-7803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

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