Provider Demographics
NPI:1770311383
Name:RXGENIUS LLC
Entity type:Organization
Organization Name:RXGENIUS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAZEM
Authorized Official - Middle Name:HAGHIR
Authorized Official - Last Name:EBRAHIMABADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-898-6436
Mailing Address - Street 1:195 PEARL NIX PKWY STE 5
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3566
Mailing Address - Country:US
Mailing Address - Phone:678-898-6436
Mailing Address - Fax:
Practice Address - Street 1:195 PEARL NIX PKWY STE 5
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3566
Practice Address - Country:US
Practice Address - Phone:678-898-6436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-24
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003315086AMedicaid