Provider Demographics
NPI:1598395030
Name:OFFICERX SPECIALTY PHARMACY INC.
Entity Type:Organization
Organization Name:OFFICERX SPECIALTY PHARMACY INC.
Other - Org Name:OFFICERX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:631-486-9898
Mailing Address - Street 1:2130 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-1306
Mailing Address - Country:US
Mailing Address - Phone:631-486-9898
Mailing Address - Fax:631-486-9895
Practice Address - Street 1:2130 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-1306
Practice Address - Country:US
Practice Address - Phone:631-486-9898
Practice Address - Fax:631-486-9895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY037855OtherPHARMACY LICENSE