MEDICARE: PHYSICIANS RX PHARMACY LLC

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	333600000X	Pharmacy	054.018661	IL
2	3336C0003X	Community/Retail Pharmacy	NRX0000450	DC
3	3336S0011X	Specialty Pharmacy
4	3336C0003X	Community/Retail Pharmacy	P06366	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2139016	OTHER	PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710225008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIANS RX PHARMACY LLC

Provider Business Mailing Address
First Line	:	9701 APOLLO DR STE 400
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-4791
Country	:	US
Telephone Number	:	301-477-3367
Fax Number	:	866-354-1868

Provider Business Practice Location Address
First Line	:	9701 APOLLO DR STE 400
Second Line	:
City	:	LARGO
State	:	MD
Zip	:	20774-4791
Country	:	US
Telephone Number	:	301-477-3367
Fax Number	:	866-354-1868

Authorized Official
Title or Position	:	CORPORATE MANAGER
Name	:	CHRIS WAKEFIELD
Credential	:
Telephone Number	:	412-477-7803

Provider Enumeration Date	:	01/22/2013
Last Update Date	:	04/11/2024

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Directions to “PHYSICIANS RX PHARMACY LLC ” Practice Location

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