1407520042 NPI number — OPRX PHARMACY #10510, LLC

Table of content: (NPI 1407520042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407520042 NPI number — OPRX PHARMACY #10510, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPRX PHARMACY #10510, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VALUE DRUGS PHARMACY - BRIARCLIFF MANOR
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407520042
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
89 N STATE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIARCLIFF MANOR
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10510-1415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-941-1970
Provider Business Mailing Address Fax Number:
914-941-4381

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
89 N STATE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIARCLIFF MANOR
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10510-1415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-941-1970
Provider Business Practice Location Address Fax Number:
914-941-4381
Provider Enumeration Date:
08/06/2021

Additional Information

Authorized Official

Authorized Official Last Name:
ROY
Authorized Official First Name:
SARIT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
516-876-0737

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 28RO00244800 . This is a "NJ BOP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 039237 . This is a "NYS BOP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0984833 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 07370212 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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