Provider Demographics
NPI:1205327913
Name:SHERIDAN RX INC
Entity type:Organization
Organization Name:SHERIDAN RX INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISKIYAYEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-502-9540
Mailing Address - Street 1:1030 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-6100
Mailing Address - Country:US
Mailing Address - Phone:718-502-9540
Mailing Address - Fax:718-502-8045
Practice Address - Street 1:1030 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456
Practice Address - Country:US
Practice Address - Phone:718-502-9540
Practice Address - Fax:718-502-8045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2178021OtherPK