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General NPI Number Information
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NPI Number | 1033247986
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Entity Type | Organization
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Legal Business Name | DENTAL RX INC.
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 10/31/2007
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Provider Practice Location Address
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Address Line | 1190 EDGEWOOD AVE W SUITE B.
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City | JACKSONVILLE
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State | FL
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Zip | 32208-3419
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Country | US
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Telephone | 904-764-8280
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Fax | 904-764-6625
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Provider Business Mailing Address
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Address Line | 1190 EDGEWOOD AVE W SUITE B.
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City | JACKSONVILLE
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State | FL
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Zip | 32208-3419
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Country | US
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Telephone | 904-764-8280
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Fax | 904-764-6625
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Authorized Official
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Title or Position | PRESIDENT
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Name | IRA RILEY JR.
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Credential | R.P.H.
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Telephone | 904-764-8280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH21099
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License Number State | FL
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