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NPI Code Detail

MEDICARE: BLACK STAR RX INC.

MEDICARE: BLACK STAR RX INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy

General Provider Information

NPI Number : 1578412474
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLACK STAR RX INC.
Provider Business Mailing Address
First Line : 2000 CONEY ISLAND AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11223-2329
Country : US
Telephone Number : 718-280-2000
Fax Number :
Provider Business Practice Location Address
First Line : 2000 CONEY ISLAND AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11223-2329
Country : US
Telephone Number : 718-280-2000
Fax Number :
Authorized Official
Title or Position : OWNER
Name : ELFAR KHANANAYEV
Credential :
Telephone Number : 718-280-2000
Provider Enumeration Date : 01/23/2026
Last Update Date : 01/23/2026

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