Provider Demographics
NPI:1629416045
Name:PRIME RX PHARMACY INC.
Entity Type:Organization
Organization Name:PRIME RX PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAIMOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-771-9220
Mailing Address - Street 1:7517 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1849
Mailing Address - Country:US
Mailing Address - Phone:718-296-0202
Mailing Address - Fax:718-880-1818
Practice Address - Street 1:7517 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-1849
Practice Address - Country:US
Practice Address - Phone:718-296-0202
Practice Address - Fax:718-880-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6844710001Medicare NSC