Provider Demographics
NPI:1821329731
Name:TOTAL CARE RX, INC.
Entity Type:Organization
Organization Name:TOTAL CARE RX, INC.
Other - Org Name:WORLDSFAIR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:NISIMOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-762-7111
Mailing Address - Street 1:22310 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3645
Mailing Address - Country:US
Mailing Address - Phone:718-762-7111
Mailing Address - Fax:718-762-7140
Practice Address - Street 1:22310 UNION TPKE
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-3645
Practice Address - Country:US
Practice Address - Phone:718-762-7111
Practice Address - Fax:718-764-6491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-18
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PANP000014333600000X
NY0300563336C0003X
3336L0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102694656Medicaid
AZ463837Medicaid
IN300023347Medicaid
CT8039848Medicaid
NJ0605409Medicaid
VT1034646Medicaid
OH0300675Medicaid
NY00263254Medicaid
2123846OtherPK