Provider Demographics
NPI:1235626557
Name:ALICE RX CORP
Entity Type:Organization
Organization Name:ALICE RX CORP
Other - Org Name:ALICE RX CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AVITAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLOKANDOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-502-6969
Mailing Address - Street 1:231 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-5601
Mailing Address - Country:US
Mailing Address - Phone:718-502-6969
Mailing Address - Fax:718-502-6979
Practice Address - Street 1:231 S 3RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-5601
Practice Address - Country:US
Practice Address - Phone:718-502-6969
Practice Address - Fax:718-502-6979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-23
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177386OtherPK