Provider Demographics
NPI:1730440702
Name:RX MARINE INC
Entity type:Organization
Organization Name:RX MARINE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:I
Authorized Official - Last Name:SIGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-310-7099
Mailing Address - Street 1:5580 E. GRANT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822
Mailing Address - Country:US
Mailing Address - Phone:786-310-7099
Mailing Address - Fax:786-332-4069
Practice Address - Street 1:5580 E. GRANT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822
Practice Address - Country:US
Practice Address - Phone:786-310-7099
Practice Address - Fax:786-332-4069
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEAR SCRIPT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-06
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH261533336C0003X
333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022863200Medicaid
FL117090600Medicaid
2135750OtherPK