Provider Demographics
NPI:1023500501
Name:REXTOX CONSULTANT LLC
Entity type:Organization
Organization Name:REXTOX CONSULTANT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNSUSI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:678-478-9511
Mailing Address - Street 1:7525 COVINGTON HWY STE G
Mailing Address - Street 2:
Mailing Address - City:STONECREST
Mailing Address - State:GA
Mailing Address - Zip Code:30058-7439
Mailing Address - Country:US
Mailing Address - Phone:678-292-6025
Mailing Address - Fax:678-292-6922
Practice Address - Street 1:7525 COVINGTON HWY STE G
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-7439
Practice Address - Country:US
Practice Address - Phone:678-292-6025
Practice Address - Fax:678-292-6922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0106333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy