Provider Demographics
NPI:1689047565
Name:LIFECARE RX INC.
Entity Type:Organization
Organization Name:LIFECARE RX INC.
Other - Org Name:MED SCRIPT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDUART
Authorized Official - Middle Name:
Authorized Official - Last Name:BORUKHOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-658-9300
Mailing Address - Street 1:8342 PARSONS BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1642
Mailing Address - Country:US
Mailing Address - Phone:718-658-9300
Mailing Address - Fax:718-658-2700
Practice Address - Street 1:8342 PARSONS BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1642
Practice Address - Country:US
Practice Address - Phone:718-658-9300
Practice Address - Fax:718-658-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
NY0345103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159669OtherPK