Provider Demographics
NPI:1245031814
Name:KHRUSTAL RX INC
Entity type:Organization
Organization Name:KHRUSTAL RX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BABAYEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-877-6390
Mailing Address - Street 1:181 AMSTERDAM AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5024
Mailing Address - Country:US
Mailing Address - Phone:212-877-6390
Mailing Address - Fax:212-877-6706
Practice Address - Street 1:181 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5024
Practice Address - Country:US
Practice Address - Phone:212-877-6390
Practice Address - Fax:212-877-6706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy