Healthcare Provider Details

I. General information

NPI: 1316773427
Provider Name (Legal Business Name): RXVIP PA 3, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 W BARR ST
MC DONALD PA
15057-1423
US

IV. Provider business mailing address

27 MARKET ST
BROWNSVILLE PA
15417-1787
US

V. Phone/Fax

Practice location:
  • Phone: 724-926-2117
  • Fax: 724-926-8129
Mailing address:
  • Phone: 724-785-7095
  • Fax: 724-785-7098

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 Number
License Number State

VIII. Authorized Official

Name: ANDREA BOURQUE
Title or Position: RXVIP TRUST MANAGER
Credential:
Phone: 337-334-3399