Healthcare Provider Details

I. General information

NPI: 1669544458
Provider Name (Legal Business Name): RIX PHARMACY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 BROADWAY ST SUITE 100
ALEXANDRIA MN
56308-3007
US

IV. Provider business mailing address

PO BOX 295
ALEXANDRIA MN
56308-0295
US

V. Phone/Fax

Practice location:
  • Phone: 320-763-3146
  • Fax: 320-763-7231
Mailing address:
  • Phone: 320-763-3146
  • Fax: 320-763-7231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number262092
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RICHARD PETTY
Title or Position: OWNER
Credential: RPH
Phone: 320-760-8471