Provider Demographics
NPI:1447725163
Name:RADIANCE HEALTH RX LLC
Entity type:Organization
Organization Name:RADIANCE HEALTH RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:407-234-5873
Mailing Address - Street 1:9345 SHEPTON ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-3788
Mailing Address - Country:US
Mailing Address - Phone:407-234-5873
Mailing Address - Fax:855-828-8066
Practice Address - Street 1:723 VIRGINIA DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-2527
Practice Address - Country:US
Practice Address - Phone:407-234-5873
Practice Address - Fax:855-828-8066
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADIANCE HEALTH AND BEAUTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy