Provider Demographics
NPI:1851762256
Name:REGAL REMEDIES RX INC
Entity Type:Organization
Organization Name:REGAL REMEDIES RX INC
Other - Org Name:REGAL REMEDIES RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-996-6815
Mailing Address - Street 1:19A OLYMPIA BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4309
Mailing Address - Country:US
Mailing Address - Phone:718-442-2222
Mailing Address - Fax:718-442-2265
Practice Address - Street 1:19A OLYMPIA BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4309
Practice Address - Country:US
Practice Address - Phone:718-442-2222
Practice Address - Fax:718-442-2265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0341293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155344OtherPK