Provider Demographics
NPI:1386181659
Name:MEDIFRIENDRX SERVICES NY LLC
Entity Type:Organization
Organization Name:MEDIFRIENDRX SERVICES NY LLC
Other - Org Name:MEDIFRIENDRX PHARMACY SUNSET PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:ELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GERBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-596-2930
Mailing Address - Street 1:PO BOX 4128
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92052-4128
Mailing Address - Country:US
Mailing Address - Phone:512-596-2930
Mailing Address - Fax:760-859-3614
Practice Address - Street 1:514 49TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2010
Practice Address - Country:US
Practice Address - Phone:512-596-2930
Practice Address - Fax:760-859-3614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy