Provider Demographics
NPI:1033505540
Name:BELLEROSE RX INC
Entity Type:Organization
Organization Name:BELLEROSE RX INC
Other - Org Name:PHAMCO DRUGS & SURGICALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOUDHURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-778-8750
Mailing Address - Street 1:24815 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-1836
Mailing Address - Country:US
Mailing Address - Phone:718-749-5811
Mailing Address - Fax:718-749-5826
Practice Address - Street 1:24815 UNION TPKE
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-1836
Practice Address - Country:US
Practice Address - Phone:718-749-5811
Practice Address - Fax:718-749-5826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY17033424OtherSTATE BOARD OF PHARMACY