Provider Demographics
NPI:1831819697
Name:BLUE POND RX INC
Entity type:Organization
Organization Name:BLUE POND RX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARKADIY
Authorized Official - Middle Name:
Authorized Official - Last Name:AMINOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-930-2939
Mailing Address - Street 1:115 W 128TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-3012
Mailing Address - Country:US
Mailing Address - Phone:646-930-2939
Mailing Address - Fax:646-930-2940
Practice Address - Street 1:115 W 128TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-3012
Practice Address - Country:US
Practice Address - Phone:646-930-2939
Practice Address - Fax:646-930-2940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-31
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy