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General NPI Number Information
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NPI Number | 1386067007
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Entity Type | Organization
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Legal Business Name | MEDRX SPECIALTY PHARMACY, LLC.
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Dates
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Enumeration Date | 01/31/2014
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Last Update Date | 02/08/2017
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Provider Practice Location Address
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Address Line | 4726 E TEXAS ST SUITE 230
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City | BOSSIER CITY
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State | LA
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Zip | 71111-2545
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Country | US
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Telephone | 855-825-5014
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Fax | 855-848-1141
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Provider Business Mailing Address
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Address Line | P.O. BOX 2188
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City | CYPRESS
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State | TX
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Zip | 77410
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Country | US
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Telephone | 713-303-3189
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Fax | 855-848-1141
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | MR. JERMAINE CHRISTOPHER ALLEN
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Credential |
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Telephone | 713-303-3189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY.6828
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License Number State | LA
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