Provider Demographics
NPI:1780699462
Name:MED RX PHARMACY, INC
Entity type:Organization
Organization Name:MED RX PHARMACY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:IZABELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BINAMINOVA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-897-8500
Mailing Address - Street 1:9727 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2103
Mailing Address - Country:US
Mailing Address - Phone:718-897-8500
Mailing Address - Fax:718-897-5499
Practice Address - Street 1:9727 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2103
Practice Address - Country:US
Practice Address - Phone:718-897-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0270453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02710350Medicaid
NY02710350Medicaid