Provider Demographics
NPI:1609029297
Name:OXYBORA DISTRIBUTING, LLC
Entity Type:Organization
Organization Name:OXYBORA DISTRIBUTING, LLC
Other - Org Name:BEST AID PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RABICHEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-877-2842
Mailing Address - Street 1:4335 EXCELSIOR BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4811
Mailing Address - Country:US
Mailing Address - Phone:952-922-4444
Mailing Address - Fax:952-922-4455
Practice Address - Street 1:4335 EXCELSIOR BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-4811
Practice Address - Country:US
Practice Address - Phone:952-922-4444
Practice Address - Fax:952-922-4455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
MN2632623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2117770OtherPK