=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104220748
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RX FOR HEALTHY SOLUTIONS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2014
-----------------------------------------------------
Last Update Date | 09/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6635 FALLS OF NEUSE RD
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27615-6816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-676-6161
-----------------------------------------------------
Fax | 919-676-6575
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6635 FALLS OF NEUSE RD
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27615-6816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-676-6161
-----------------------------------------------------
Fax | 919-676-6575
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | BOBBIE BARBREY
-----------------------------------------------------
Credential | RPH, CCN
-----------------------------------------------------
Telephone | 919-676-6161
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 07829
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------