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General NPI Number Information
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NPI Number | 1104192335
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Entity Type | Organization
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Legal Business Name | RX PRO PHARMACY & COMPOUNDING, INC
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Dates
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Enumeration Date | 04/02/2012
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Last Update Date | 04/02/2012
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Provider Practice Location Address
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Address Line | 932 W HALLANDALE BEACH BLVD
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-5241
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Country | US
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Telephone | 954-455-0004
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Fax | 601-982-7103
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Provider Business Mailing Address
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Address Line | 932 W HALLANDALE BEACH BLVD
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-5241
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Country | US
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Telephone | 954-455-0004
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Fax | 601-982-7103
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Authorized Official
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Title or Position | PRESIDENT
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Name | JASON DAVID RUTLAND
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Credential |
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Telephone | 954-455-0004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH26011
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License Number State | FL
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