Provider Demographics
NPI:1639819444
Name:63RD RX CORP.
Entity type:Organization
Organization Name:63RD RX CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKZANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-897-4747
Mailing Address - Street 1:9855 63RD RD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1739
Mailing Address - Country:US
Mailing Address - Phone:718-897-4747
Mailing Address - Fax:718-897-4748
Practice Address - Street 1:9855 63RD RD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1739
Practice Address - Country:US
Practice Address - Phone:718-897-4747
Practice Address - Fax:718-897-4748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies