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General NPI Number Information
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NPI Number | 1538496443
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Entity Type | Organization
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Legal Business Name | SSRX LLC
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Dates
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Enumeration Date | 11/13/2009
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 6330 WEST LOOP SOUTH STE. 700 C
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City | BELLAIRE
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State | TX
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Zip | 77401-2928
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Country | US
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Telephone | 832-553-1374
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Fax | 855-822-7838
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Provider Business Mailing Address
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Address Line | 6330 WEST LOOP SOUTH STE. 700
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City | BELLAIRE
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State | TX
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Zip | 77401-2928
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Country | US
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Telephone | 832-553-1374
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Fax | 855-822-7838
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Authorized Official
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Title or Position | COO-OFFICER
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Name | MARK FETCENKO
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Credential |
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Telephone | 832-533-1301
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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 | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 26659
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License Number State | TX
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