Provider Demographics
NPI:1669839536
Name:FLATBUSH RX CORP
Entity Type:Organization
Organization Name:FLATBUSH RX CORP
Other - Org Name:FLATBUSH RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GERGES
Authorized Official - Middle Name:
Authorized Official - Last Name:AZEEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-677-4067
Mailing Address - Street 1:1855 FLATBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4840
Mailing Address - Country:US
Mailing Address - Phone:718-677-4067
Mailing Address - Fax:718-677-4209
Practice Address - Street 1:1855 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4840
Practice Address - Country:US
Practice Address - Phone:718-677-4067
Practice Address - Fax:718-677-4209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0342653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157729OtherPK