Provider Demographics
NPI:1780035105
Name:MOTT HAVEN RX INC
Entity Type:Organization
Organization Name:MOTT HAVEN RX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAGRUTI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-292-9144
Mailing Address - Street 1:400 E 141ST ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-2212
Mailing Address - Country:US
Mailing Address - Phone:718-292-9144
Mailing Address - Fax:718-292-9145
Practice Address - Street 1:400 E 141ST ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-2212
Practice Address - Country:US
Practice Address - Phone:718-292-9144
Practice Address - Fax:718-292-9145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy