Provider Demographics
NPI:1487690863
Name:PAX RX LLC
Entity type:Organization
Organization Name:PAX RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:775-348-1406
Mailing Address - Street 1:PO BOX 17448
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3515 AIRWAY DR
Practice Address - Street 2:STE 210
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1849
Practice Address - Country:US
Practice Address - Phone:775-851-7788
Practice Address - Fax:775-851-7787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BN1400X, 333600000X, 3336L0003X, 3336M0002X, 332B00000X, 332BD1200X
NVPH021163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2989311OtherOTHER ID NUMBER
NV28100507944Medicaid
2989311OtherOTHER ID NUMBER-COMMERCIAL NUMBER
NV3310050782Medicaid
NV37100507983Medicaid
2989311OtherOTHER ID NUMBER