Provider Demographics
NPI:1740753441
Name:VALLEY STREAM RX INC
Entity Type:Organization
Organization Name:VALLEY STREAM RX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NIKITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUMENTAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-573-1823
Mailing Address - Street 1:209 ROCKAWAY AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5825
Mailing Address - Country:US
Mailing Address - Phone:516-284-7257
Mailing Address - Fax:516-612-2639
Practice Address - Street 1:209 ROCKAWAY AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5825
Practice Address - Country:US
Practice Address - Phone:516-284-7257
Practice Address - Fax:516-612-2639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-04
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy