Provider Demographics
NPI:1548345945
Name:RXPERT #1 LLC
Entity type:Organization
Organization Name:RXPERT #1 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-272-1670
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:SUITE 1
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:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH215961835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatricGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1015329OtherNCPDP
FL31132400Medicaid