Provider Demographics
NPI:1346371275
Name:CORAM RX LTD
Entity Type:Organization
Organization Name:CORAM RX LTD
Other - Org Name:PRESCRIPTION CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-698-2868
Mailing Address - Street 1:35H MIDDLE COUNTRY RD H
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-4404
Mailing Address - Country:US
Mailing Address - Phone:631-698-2868
Mailing Address - Fax:631-698-0119
Practice Address - Street 1:35H MIDDLE COUNTRY RD H
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-4404
Practice Address - Country:US
Practice Address - Phone:631-698-2868
Practice Address - Fax:631-698-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0215993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2995302Medicaid
2064982OtherPK