MEDICARE: MRX ENTERPRISES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	021712250	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679763346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MRX ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 898
Second Line	:	2535 WESTERN AVENUE
City	:	CHILLICOTHEE
State	:	OH
Zip	:	45601-0898
Country	:	US
Telephone Number	:	740-779-6226
Fax Number	:	740-779-6228

Provider Business Practice Location Address
First Line	:	2535 WESTERN AVE
Second Line	:
City	:	CHILLICOTHEE
State	:	OH
Zip	:	45601
Country	:	US
Telephone Number	:	740-779-6226
Fax Number	:	740-779-6228

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MATTHEW RYAN KNISLEY
Credential	:	PHARMD
Telephone Number	:	740-779-6226

Provider Enumeration Date	:	07/30/2007
Last Update Date	:	04/29/2009

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