Provider Demographics
NPI:1194011486
Name:COMMUNITY CARE RX INC.
Entity Type:Organization
Organization Name:COMMUNITY CARE RX INC.
Other - Org Name:COMMUNITY CARE RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOSSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKSOUD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:347-561-3806
Mailing Address - Street 1:131 SUNNYSIDE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1539
Mailing Address - Country:US
Mailing Address - Phone:347-561-3806
Mailing Address - Fax:347-561-3835
Practice Address - Street 1:131 SUNNYSIDE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1539
Practice Address - Country:US
Practice Address - Phone:347-561-3806
Practice Address - Fax:347-561-3835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-24
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X
NY0306323336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2130890OtherPK
NY03361126Medicaid
6586480001Medicare NSC