Healthcare Provider Details

I. General information

NPI: 1477436673
Provider Name (Legal Business Name): RX EXPRESS OF PACE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6775 CHUMUCKLA HWY
PACE FL
32571
US

IV. Provider business mailing address

6775 CHUMUCKLA HWY
PACE FL
32571
US

V. Phone/Fax

Practice location:
  • Phone: 850-889-8990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW ETHEREDGE
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 850-889-8990