Provider Demographics
NPI:1952912792
Name:ELIOT RX PHARMACY INC
Entity Type:Organization
Organization Name:ELIOT RX PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VYACHESLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:MASHKABOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-916-8345
Mailing Address - Street 1:8218 ELIOT AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11379-1437
Mailing Address - Country:US
Mailing Address - Phone:718-406-9222
Mailing Address - Fax:
Practice Address - Street 1:8218 ELIOT AVE
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1437
Practice Address - Country:US
Practice Address - Phone:718-406-9222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy