Healthcare Provider Details

I. General information

NPI: 1063871812
Provider Name (Legal Business Name): RXSHOP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1571 KY HIGHWAY 259 N
BROWNSVILLE KY
42210-9206
US

IV. Provider business mailing address

1571 KY HIGHWAY 259 N PO BOX 540
BROWNSVILLE KY
42210-9206
US

V. Phone/Fax

Practice location:
  • Phone: 270-597-2181
  • Fax: 270-597-3232
Mailing address:
  • Phone: 270-597-2181
  • Fax: 270-597-3232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RANDALL T YOUNG
Title or Position: MANAGER
Credential: RPH
Phone: 270-597-2181