=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790013159
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCTAVIORX ENTERPRISES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2009
-----------------------------------------------------
Last Update Date | 09/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 HANNAH'S REST
-----------------------------------------------------
City | FREDERIKSTED
-----------------------------------------------------
State | VI
-----------------------------------------------------
Zip | 00840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 340-772-0093
-----------------------------------------------------
Fax | 340-772-0095
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 485
-----------------------------------------------------
City | FREDERIKSTED
-----------------------------------------------------
State | VI
-----------------------------------------------------
Zip | 00841-0485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 340-772-2234
-----------------------------------------------------
Fax | 340-772-2236
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GERARD CHRISTIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 340-772-0093
-----------------------------------------------------
=====================================================
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 | 241361L
-----------------------------------------------------
License Number State | VI
-----------------------------------------------------