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General NPI Number Information
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NPI Number | 1194141176
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Entity Type | Organization
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Legal Business Name | EASY RX PAD, LLC
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Dates
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Enumeration Date | 03/13/2014
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Last Update Date | 02/28/2019
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Provider Practice Location Address
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Address Line | 264 SMITH TOWNSHIP STATE RD SUITE 5
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City | BURGETTSTOWN
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State | PA
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Zip | 15021-2124
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Country | US
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Telephone | 855-335-8219
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Fax | 855-789-1959
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Provider Business Mailing Address
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Address Line | 4249 SUNSET BLVD
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City | STEUBENVILLE
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State | OH
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Zip | 43952-3617
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Country | US
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Telephone | 855-335-8219
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Fax | 855-789-1959
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Authorized Official
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Title or Position | VP, PHARMACY MANAGER
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Name | DR. MICHELLE MIKUS
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Credential | PHARMD
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Telephone | 724-414-1425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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