Healthcare Provider Details

I. General information

NPI: 1710225008
Provider Name (Legal Business Name): PHYSICIANS RX PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 APOLLO DR STE 400
LARGO MD
20774-4791
US

IV. Provider business mailing address

9701 APOLLO DR STE 400
LARGO MD
20774-4791
US

V. Phone/Fax

Practice location:
  • Phone: 301-477-3367
  • Fax: 866-354-1868
Mailing address:
  • Phone: 301-477-3367
  • Fax: 866-354-1868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number054.018661
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberNRX0000450
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP06366
License Number StateMD

VIII. Authorized Official

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