Provider Demographics
NPI:1689976953
Name:HARLEM RX INC.
Entity Type:Organization
Organization Name:HARLEM RX INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AJANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOMMAREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-666-8100
Mailing Address - Street 1:102 W 116TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-2500
Mailing Address - Country:US
Mailing Address - Phone:212-666-8100
Mailing Address - Fax:212-666-8109
Practice Address - Street 1:102 W 116TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-2500
Practice Address - Country:US
Practice Address - Phone:212-666-8100
Practice Address - Fax:212-666-8109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0303633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6490140001Medicare NSC