Organization
RX TRADER INC
Active
Other names
GlenRock Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
CURTIS HAGUE (OWENR)
(323) 551-5906
Entity
Organization
Contact information
Practice address
2256 COLORADO BLVD, SUITES 107 & 108, EAGLE ROCK, CA 90041-1164
(323) 551-5906
(323) 551-5908
Mailing address
2256 COLORADO BLVD, SUITES 107 & 108, EAGLE ROCK, CA 90041-1164
(323) 551-5906
(323) 551-5908
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
51609
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2144187
PK
—
Enumeration date
02/28/2007
Last updated
09/11/2014
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