Provider Demographics
NPI:1851784466
Name:MADISON RX PHARMACY INC.
Entity Type:Organization
Organization Name:MADISON RX PHARMACY INC.
Other - Org Name:MADISON RX PHARMACY INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:646-918-7225
Mailing Address - Street 1:203 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-7581
Mailing Address - Country:US
Mailing Address - Phone:646-918-7225
Mailing Address - Fax:646-682-9216
Practice Address - Street 1:203 MADISON ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-7581
Practice Address - Country:US
Practice Address - Phone:646-918-7225
Practice Address - Fax:646-682-9216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-07
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0334273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04173011Medicaid
NY5812892OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NY7373330001Medicare NSC