Provider Demographics
NPI:1730428582
Name:EVEXIA RX, LLC
Entity type:Organization
Organization Name:EVEXIA RX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:952-444-2857
Mailing Address - Street 1:5206 W 84TH ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-1308
Mailing Address - Country:US
Mailing Address - Phone:952-444-2857
Mailing Address - Fax:952-426-1464
Practice Address - Street 1:5206 W 84TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-1308
Practice Address - Country:US
Practice Address - Phone:952-444-2857
Practice Address - Fax:952-426-1464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2639913336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy