Provider Demographics
NPI:1619256120
Name:LEV RX CORP
Entity Type:Organization
Organization Name:LEV RX CORP
Other - Org Name:KIRA'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:VIKTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRINBLAT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-676-4343
Mailing Address - Street 1:88 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1510
Mailing Address - Country:US
Mailing Address - Phone:718-646-4343
Mailing Address - Fax:718-676-7030
Practice Address - Street 1:88 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1510
Practice Address - Country:US
Practice Address - Phone:718-646-4343
Practice Address - Fax:718-676-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-15
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0310533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133743OtherPK
NY03361171Medicaid
2133743OtherPK