Provider Demographics
NPI:1295812162
Name:MEDRX INC
Entity type:Organization
Organization Name:MEDRX INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER/SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:DMITRY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAYGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-343-3443
Mailing Address - Street 1:18356 OXNARD ST
Mailing Address - Street 2:STE 1
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1555
Mailing Address - Country:US
Mailing Address - Phone:818-343-3443
Mailing Address - Fax:818-343-0933
Practice Address - Street 1:18356 OXNARD ST
Practice Address - Street 2:STE 1
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1555
Practice Address - Country:US
Practice Address - Phone:818-343-3443
Practice Address - Fax:818-343-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY 492093336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5616416OtherOTHER ID NUMBER-COMMERCIAL NUMBER
5616416OtherOTHER ID NUMBER
CAPHA 471890Medicaid