Provider Demographics
NPI:1881190692
Name:CITYWIDE RX LLC
Entity Type:Organization
Organization Name:CITYWIDE RX LLC
Other - Org Name:SPECIALTY RX OH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUPNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-241-6337
Mailing Address - Street 1:2 BERGEN TPKE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-2390
Mailing Address - Country:US
Mailing Address - Phone:908-241-6337
Mailing Address - Fax:908-634-4038
Practice Address - Street 1:2787 CHARTER ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-4607
Practice Address - Country:US
Practice Address - Phone:614-407-8000
Practice Address - Fax:614-407-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH02286655003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0301114Medicaid
2176772OtherPK