Healthcare Provider Details

I. General information

NPI: 1497244131
Provider Name (Legal Business Name): MRLRX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 E 10TH ST
MARCUS HOOK PA
19061-4515
US

IV. Provider business mailing address

PO BOX 428
MARCUS HOOK PA
19061-0428
US

V. Phone/Fax

Practice location:
  • Phone: 610-485-7750
  • Fax: 610-485-2459
Mailing address:
  • Phone: 610-485-7750
  • Fax: 610-485-2459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP412293L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARK LAWSON
Title or Position: PRESIDENT
Credential:
Phone: 267-979-3948