Provider Demographics
NPI:1174565014
Name:MEDIRX INC PA
Entity type:Organization
Organization Name:MEDIRX INC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:H
Authorized Official - Last Name:DALEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:785-825-0524
Mailing Address - Street 1:321 S BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-3803
Mailing Address - Country:US
Mailing Address - Phone:782-825-0524
Mailing Address - Fax:785-825-6540
Practice Address - Street 1:321 S BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-3803
Practice Address - Country:US
Practice Address - Phone:782-825-0524
Practice Address - Fax:785-825-6540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
KS2-087573336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100442570BMedicaid
KS100442570BMedicaid