=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356620140
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RX CHOICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2011
-----------------------------------------------------
Last Update Date | 07/05/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 E 2ND AVE
-----------------------------------------------------
City | ROME
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30161-3249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-622-2063
-----------------------------------------------------
Fax | 706-622-2752
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 501 E 2ND AVE
-----------------------------------------------------
City | ROME
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30161-3249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-622-2063
-----------------------------------------------------
Fax | 706-622-2752
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CARLOS ZIMMERMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 706-622-2063
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0004X
-----------------------------------------------------
Taxonomy Name | Compounding Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHRE009772
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------