Provider Demographics
NPI:1649415704
Name:REX SPECIALTY PHARMACY CORP
Entity Type:Organization
Organization Name:REX SPECIALTY PHARMACY CORP
Other - Org Name:CRESCENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/SUPERVISING PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:HASSAN
Authorized Official - Last Name:JAFFERY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:516-593-7747
Mailing Address - Street 1:48 CENTRAL CT
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1143
Mailing Address - Country:US
Mailing Address - Phone:516-593-7747
Mailing Address - Fax:
Practice Address - Street 1:48 CENTRAL CT
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-1143
Practice Address - Country:US
Practice Address - Phone:516-593-7747
Practice Address - Fax:516-593-7094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0291683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03047692Medicaid
3359533OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY6179950001Medicare NSC