Provider Demographics
NPI:1083913917
Name:MY RX PHARMACY INC
Entity Type:Organization
Organization Name:MY RX PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KANDOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-969-6979
Mailing Address - Street 1:17815 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1633
Mailing Address - Country:US
Mailing Address - Phone:718-969-6979
Mailing Address - Fax:718-969-4111
Practice Address - Street 1:17815 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1633
Practice Address - Country:US
Practice Address - Phone:718-969-6979
Practice Address - Fax:718-969-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0306393336C0003X, 3336C0004X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY030639OtherSTATE