Provider Demographics
NPI:1376294132
Name:PHILOMINA RX, LLC
Entity Type:Organization
Organization Name:PHILOMINA RX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BESHARA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D, CCP
Authorized Official - Phone:732-956-7535
Mailing Address - Street 1:1 PALISADES RD
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3585
Mailing Address - Country:US
Mailing Address - Phone:732-956-7535
Mailing Address - Fax:718-333-5295
Practice Address - Street 1:9006 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5908
Practice Address - Country:US
Practice Address - Phone:718-333-5304
Practice Address - Fax:718-333-5295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy