Provider Demographics
NPI:1093452559
Name:AMENIA PHARMACY RX LLC
Entity Type:Organization
Organization Name:AMENIA PHARMACY RX LLC
Other - Org Name:AMENIA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-839-0929
Mailing Address - Street 1:5094 ROUTE 22 # 48
Mailing Address - Street 2:
Mailing Address - City:AMENIA
Mailing Address - State:NY
Mailing Address - Zip Code:12501-5355
Mailing Address - Country:US
Mailing Address - Phone:845-373-8000
Mailing Address - Fax:845-373-8236
Practice Address - Street 1:5094 ROUTE 22 # 48
Practice Address - Street 2:
Practice Address - City:AMENIA
Practice Address - State:NY
Practice Address - Zip Code:12501-5355
Practice Address - Country:US
Practice Address - Phone:845-373-8000
Practice Address - Fax:845-373-8236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-17
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy