Healthcare Provider Details

I. General information

NPI: 1609890060
Provider Name (Legal Business Name): RXDIRECT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16246 SE MCLOUGHLIN BLVD
MILWAUKIE OR
97267-4657
US

IV. Provider business mailing address

16246 SE MCLOUGHLIN BLVD
MILWAUKIE OR
97267-4657
US

V. Phone/Fax

Practice location:
  • Phone: 503-657-9422
  • Fax: 503-656-0278
Mailing address:
  • Phone: 503-657-9422
  • Fax: 503-656-0278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberIP-0001408-CS
License Number StateOR

VIII. Authorized Official

Name: PETER T NG
Title or Position: CEO
Credential: RPH
Phone: 503-657-9422