Organization
EXPRESS MEDS RX LLC
Active
Other names
EXPRESS MEDS RX LLC
Organization subpart
No
Provider details
NPI number
Authorized official
RICARDO LUACES (VP)
(239) 936-1041
Entity
Organization
Contact information
Practice address
1860 BOY SCOUT DR, STE 201, FORT MYERS, FL 33907-2144
(239) 274-3269
(239) 936-1761
Mailing address
PO BOX 9830, SALT LAKE CITY, UT 84109-9830
(801) 716-4721
(801) 716-4872
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH22069
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1019834
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
31346700
—
FL
Enumeration date
08/10/2006
Last updated
09/16/2011
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