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General NPI Number Information
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NPI Number | 1316773427
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Entity Type | Organization
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Legal Business Name | RXVIP PA 3, LLC
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Dates
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Enumeration Date | 09/13/2024
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 303 W BARR ST
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City | MC DONALD
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State | PA
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Zip | 15057-1423
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Country | US
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Telephone | 724-926-2117
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Fax | 724-926-8129
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Provider Business Mailing Address
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Address Line | 27 MARKET ST
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City | BROWNSVILLE
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State | PA
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Zip | 15417-1787
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Country | US
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Telephone | 724-785-7095
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Fax | 724-785-7098
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Authorized Official
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Title or Position | RXVIP TRUST MANAGER
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Name | ANDREA BOURQUE
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Credential |
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Telephone | 337-334-3399
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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