Provider Demographics
NPI:1922025600
Name:RXPERT 1 LLC
Entity type:Organization
Organization Name:RXPERT 1 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:SAWICKI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:904-272-1690
Mailing Address - Street 1:2177 KINGSLEY AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5199
Mailing Address - Country:US
Mailing Address - Phone:904-272-1690
Mailing Address - Fax:904-272-1691
Practice Address - Street 1:2177 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5199
Practice Address - Country:US
Practice Address - Phone:904-272-1690
Practice Address - Fax:904-272-1691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH215963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031132400Medicaid
2005362OtherPK