Provider Demographics
NPI:1831555309
Name:RXVIP LLC
Entity type:Organization
Organization Name:RXVIP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER, AO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-605-0265
Mailing Address - Street 1:PO BOX 4118
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70434-4118
Mailing Address - Country:US
Mailing Address - Phone:985-605-0265
Mailing Address - Fax:985-249-6823
Practice Address - Street 1:2190 MANTON DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-1000
Practice Address - Country:US
Practice Address - Phone:985-605-0265
Practice Address - Fax:985-249-6823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY.007283-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157584OtherPK