Provider Demographics
NPI:1548894322
Name:PAYSON RX EXPRESS LLC
Entity type:Organization
Organization Name:PAYSON RX EXPRESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-609-2300
Mailing Address - Street 1:869 TURF FARM RD
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-5709
Mailing Address - Country:US
Mailing Address - Phone:801-609-2300
Mailing Address - Fax:
Practice Address - Street 1:869 TURF FARM RD
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-5709
Practice Address - Country:US
Practice Address - Phone:801-609-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy