Healthcare Provider Details

I. General information

NPI: 1508053075
Provider Name (Legal Business Name): RX INSTITUTIONAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 11/27/2023
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 BOARDMAN CANFIELD RD STE 340
BOARDMAN OH
44512
US

IV. Provider business mailing address

8571 FOXWOOD CT STE A
POLAND OH
44514-4313
US

V. Phone/Fax

Practice location:
  • Phone: 330-505-1979
  • Fax: 330-505-4178
Mailing address:
  • Phone: 330-318-3926
  • Fax: 330-318-3927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number02-1726050
License Number StateOH

VIII. Authorized Official

Name: MR. RONALD T MCDERMOTT JR.
Title or Position: VICE PRESIDENT
Credential: RPH
Phone: 724-699-7328