MEDICARE: REX PHARMACY 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	332B00000X	Durable Medical Equipment & Medical Supplies		IA
2	3336L0003X	Long Term Care Pharmacy	54	IA
3	333600000X	Pharmacy	54	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1609835	OTHER	NCPDP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841277282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REX PHARMACY INC

Provider Business Mailing Address
First Line	:	1607 E 7TH ST
Second Line	:
City	:	ATLANTIC
State	:	IA
Zip	:	50022-1910
Country	:	US
Telephone Number	:	712-243-2110
Fax Number	:	712-243-2064

Provider Business Practice Location Address
First Line	:	1607 E 7TH ST
Second Line	:
City	:	ATLANTIC
State	:	IA
Zip	:	50022-1910
Country	:	US
Telephone Number	:	712-243-2110
Fax Number	:	712-243-2064

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSHUA BORER
Credential	:	PHARMD
Telephone Number	:	712-243-2110

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	10/07/2019

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Directions to “REX PHARMACY INC ” Practice Location

Language	Start Address	Practice Location

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