Provider Demographics
NPI:1477200467
Name:EZRX CHEMISTS CORP.
Entity Type:Organization
Organization Name:EZRX CHEMISTS CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-776-7703
Mailing Address - Street 1:15916 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1954
Mailing Address - Country:US
Mailing Address - Phone:718-374-3178
Mailing Address - Fax:718-374-3126
Practice Address - Street 1:15916 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1954
Practice Address - Country:US
Practice Address - Phone:718-374-3178
Practice Address - Fax:718-374-3126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy