Healthcare Provider Details

I. General information

NPI: 1417795030
Provider Name (Legal Business Name): RXVIP DELRAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 S CONGRESS AVE
DELRAY BEACH FL
33445-6368
US

IV. Provider business mailing address

1601 S CONGRESS AVE
DELRAY BEACH FL
33445-6368
US

V. Phone/Fax

Practice location:
  • Phone: 561-272-0015
  • Fax:
Mailing address:
  • Phone: 561-272-0015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BRYAN SMITH
Title or Position: GENERAL MANAGER
Credential:
Phone: 954-560-1213