Healthcare Provider Details

I. General information

NPI: 1457194508
Provider Name (Legal Business Name): RXVIP PA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 RAILROAD AVE STE 2
PATTON PA
16668-1342
US

IV. Provider business mailing address

503 RAILROAD AVE STE 2
PATTON PA
16668-1342
US

V. Phone/Fax

Practice location:
  • Phone: 814-674-3693
  • Fax: 814-674-5446
Mailing address:
  • Phone: 814-674-3693
  • Fax: 814-674-5446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HANNAH MCGLYNN
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 814-674-3693