Active NPI
PRXP of Ca LLC
- Community/Retail Pharmacy
- Ontario, CA
National Provider Identifier
1154792570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- PHY55795
- Legal business name
- PRXP OF CA LLC
- Practice address
- 4345 E Lowell St
Suites C and D
Ontario, CA 91761-2222 - Phone
- (760) 326-2312
- Fax
- (760) 326-4178
- NPI assigned
- Oct 12, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Chris Wakefield
- Title
- Corporate Manager
- Phone
- (412) 477-7803
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | PHY55795 | CA | Primary |
| Specialty Pharmacy | 3336S0011X |
Addresses
Primary practice location
4345 E Lowell St
Suites C and D
Ontario, CA 91761-2222
Mailing address
4345 E Lowell St
Suites C & D
Ontario, CA 91761-2222
Phone (888) 505-1485
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2162397 | Other | PK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210416001899 | CA | DME Supplier - Pharmacy | 4789092446 | Practice locations: Ontario, CA |
National Provider Directory
National Provider Directory- Tax ID family
- PRXP of Ca LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Pharmacy
- Ontario, CA
- NPI 1104665173
Locations
4345 E Lowell St
Ste C
Ontario, CA 91761
Phone (760) 326-2312
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1444608000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1712793600000",
"number": "1154792570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4345 E LOWELL ST",
"address_2": "SUITES C & D",
"city": "ONTARIO",
"state": "CA",
"postal_code": "917612222",
"telephone_number": "888-505-1485",
"fax_number": "888-505-1485"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4345 E LOWELL ST",
"address_2": "SUITES C AND D",
"city": "ONTARIO",
"state": "CA",
"postal_code": "917612222",
"telephone_number": "760-326-2312",
"fax_number": "760-326-4178"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PRXP OF CA LLC",
"organizational_subpart": "NO",
"enumeration_date": "2015-10-12",
"last_updated": "2024-04-11",
"certification_date": "2024-04-11",
"status": "A",
"authorized_official_last_name": "WAKEFIELD",
"authorized_official_first_name": "CHRIS",
"authorized_official_title_or_position": "CORPORATE MANAGER",
"authorized_official_telephone_number": "412-477-7803"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "CA",
"license": "PHY55795",
"primary": true
},
{
"code": "3336S0011X",
"taxonomy_group": "",
"desc": "Pharmacy, Specialty Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2162397",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Ontario, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.