Provider Demographics
NPI:1679995708
Name:MLK RX GROUP LLC
Entity Type:Organization
Organization Name:MLK RX GROUP LLC
Other - Org Name:CAREMORE RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KOURANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-277-2237
Mailing Address - Street 1:2260 CROTONA AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-1939
Mailing Address - Country:US
Mailing Address - Phone:917-801-2325
Mailing Address - Fax:917-801-2326
Practice Address - Street 1:2260 CROTONA AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-1939
Practice Address - Country:US
Practice Address - Phone:917-801-2325
Practice Address - Fax:917-801-2326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NY0324683336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143812OtherPK
NY03868155Medicaid