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General NPI Number Information
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NPI Number | 1720116122
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Entity Type | Organization
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Legal Business Name | RX TRADER INC
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 09/11/2014
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Provider Practice Location Address
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Address Line | 2256 COLORADO BLVD SUITES 107 & 108
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City | EAGLE ROCK
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State | CA
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Zip | 90041-1164
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Country | US
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Telephone | 323-551-5906
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Fax | 323-551-5908
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Provider Business Mailing Address
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Address Line | 2256 COLORADO BLVD SUITES 107 & 108
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City | EAGLE ROCK
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State | CA
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Zip | 90041-1164
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Country | US
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Telephone | 323-551-5906
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Fax | 323-551-5908
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Authorized Official
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Title or Position | OWENR
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Name | CURTIS HAGUE
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Credential |
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Telephone | 323-551-5906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 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 #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 51609
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License Number State | CA
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