=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831853696
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FULFILLRX LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2021
-----------------------------------------------------
Last Update Date | 09/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3720 N 27TH ST STE D
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68521-4164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 531-220-6784
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3720 N 27TH ST STE 6
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68521-4163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 531-254-5375
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | ALI SATTAR AL-BADRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 531-220-6784
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------