Basic Information
| Provider Information | |||||||||
| NPI: | 1033658059 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACCESS RX PHARMACY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2611 WAYNE AVE | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454201833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372567801 | ||||||||
| FaxNumber: | 9372567811 | ||||||||
| Practice Location | |||||||||
| Address1: | 2611 WAYNE AVE | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454201833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372567801 | ||||||||
| FaxNumber: | 9372567811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2017 | ||||||||
| LastUpdateDate: | 04/05/2017 | ||||||||
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| AuthorizedOfficialLastName: | SHUMATE | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | RDO -PSI | ||||||||
| AuthorizedOfficialTelephone: | 4407247134 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0002X | N | Suppliers | Pharmacy | Clinic Pharmacy | 3336M0002X | N | Suppliers | Pharmacy | Mail Order Pharmacy | 333600000X | N | Suppliers | Pharmacy | 3336I0012X | 022667050 | OH | Y | Suppliers | Pharmacy | Institutional Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 2168302 | 01 | PK | OTHER |