Provider Demographics
NPI:1881007474
Name:SARATOGA RX LLC
Entity Type:Organization
Organization Name:SARATOGA RX LLC
Other - Org Name:SARATOGA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER/ PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:HABIB
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:585-458-2326
Mailing Address - Street 1:192 LYELL AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14608
Mailing Address - Country:US
Mailing Address - Phone:585-458-2326
Mailing Address - Fax:585-458-3817
Practice Address - Street 1:192 LYELL AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-1317
Practice Address - Country:US
Practice Address - Phone:585-458-2326
Practice Address - Fax:585-458-3817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0329443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03937217Medicaid
2148510OtherPK
NY5812082OtherNCPDP
2148510OtherPK