Provider Demographics
NPI:1255583928
Name:ELMHURST RX INC
Entity type:Organization
Organization Name:ELMHURST RX INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-449-0086
Mailing Address - Street 1:557 E 169TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-2625
Mailing Address - Country:US
Mailing Address - Phone:347-918-8700
Mailing Address - Fax:347-918-8701
Practice Address - Street 1:557 E 169TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-2625
Practice Address - Country:US
Practice Address - Phone:347-918-8700
Practice Address - Fax:347-918-8701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336S0011X, 332B00000X
NY0291363336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2117617OtherPK
NY3064564Medicaid
6172050001Medicare NSC