Provider Demographics
NPI:1891562211
Name:PRIME QRX CORP
Entity Type:Organization
Organization Name:PRIME QRX CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-848-2040
Mailing Address - Street 1:9716 ROCKAWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417
Mailing Address - Country:US
Mailing Address - Phone:718-848-2040
Mailing Address - Fax:718-848-2026
Practice Address - Street 1:9716 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417
Practice Address - Country:US
Practice Address - Phone:718-848-2040
Practice Address - Fax:718-848-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy