Provider Demographics
NPI:1902604127
Name:DOUGLASTON RX INC
Entity type:Organization
Organization Name:DOUGLASTON RX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIYAHU
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSUPOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-503-7078
Mailing Address - Street 1:4056 DOUGLASTON PKWY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1507
Mailing Address - Country:US
Mailing Address - Phone:347-503-7078
Mailing Address - Fax:347-235-0208
Practice Address - Street 1:4056 DOUGLASTON PKWY
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11363-1507
Practice Address - Country:US
Practice Address - Phone:347-503-7078
Practice Address - Fax:347-235-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy