Provider Demographics
NPI:1467874339
Name:CVS RX INC
Entity Type:Organization
Organization Name:CVS RX INC
Other - Org Name:EXPRESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KANDOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-997-7444
Mailing Address - Street 1:99-14 63RD ROAD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374
Mailing Address - Country:US
Mailing Address - Phone:718-997-7444
Mailing Address - Fax:718-997-7445
Practice Address - Street 1:9914 63RD RD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1940
Practice Address - Country:US
Practice Address - Phone:718-997-7444
Practice Address - Fax:718-997-7445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336S0011X, 332B00000X
NY0325863336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2145106OtherPK
NY03874884Medicaid
NY03874884Medicaid