Provider Demographics
NPI:1689562217
Name:ENEXIA PHARMACY LLC
Entity type:Organization
Organization Name:ENEXIA PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NATENZON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:917-734-4662
Mailing Address - Street 1:826 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-2446
Mailing Address - Country:US
Mailing Address - Phone:917-734-4662
Mailing Address - Fax:
Practice Address - Street 1:114 12TH ST NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44704-1024
Practice Address - Country:US
Practice Address - Phone:330-304-3311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy