=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376945493
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RX EXPRESS PHARMACY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2014
-----------------------------------------------------
Last Update Date | 03/01/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 356 US HIGHWAY 9
-----------------------------------------------------
City | MANALAPAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07726-8262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-851-7272
-----------------------------------------------------
Fax | 732-851-7271
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 356 US HIGHWAY 9
-----------------------------------------------------
City | MANALAPAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07726-8262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-851-7272
-----------------------------------------------------
Fax | 732-851-7271
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PIC
-----------------------------------------------------
Name | IRINA CHERNY
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 732-851-7272
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 28RS00735500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------