Provider Demographics
NPI:1679614721
Name:GSR RX CORP
Entity Type:Organization
Organization Name:GSR RX CORP
Other - Org Name:THE MEDICINE CABINET PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GHAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNABI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-377-2334
Mailing Address - Street 1:273 NEW MAIN ST
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-4130
Mailing Address - Country:US
Mailing Address - Phone:914-377-2334
Mailing Address - Fax:914-377-2335
Practice Address - Street 1:273 NEW MAIN ST
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-4130
Practice Address - Country:US
Practice Address - Phone:914-377-2334
Practice Address - Fax:914-377-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-10
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0269593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY026959OtherPHARMACY STATE LIC
NY02625345Medicaid
NY5328530001Medicare ID - Type Unspecified