Provider Demographics
NPI:1659644557
Name:PAYLESS RX PHARMACY. INC
Entity Type:Organization
Organization Name:PAYLESS RX PHARMACY. INC
Other - Org Name:PAYLESS RX PHARMACY INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ZARQA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-544-0020
Mailing Address - Street 1:567 WEST 207TH ST
Mailing Address - Street 2:PAYLESS RX PHARMACY. INC.
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034
Mailing Address - Country:US
Mailing Address - Phone:212-544-0020
Mailing Address - Fax:212-544-0122
Practice Address - Street 1:567 WEST 207TH ST
Practice Address - Street 2:PAYLESS RX PHARMACY. INC.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034
Practice Address - Country:US
Practice Address - Phone:212-544-0020
Practice Address - Fax:212-544-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0310663336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5804528OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY03450662Medicaid
NY03450662Medicaid