MEDICARE: ENERGIZEDHEALTH 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
1	3336S0011X	Specialty Pharmacy

General Provider Information

NPI Number	:	1760221196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENERGIZEDHEALTH RX INC

Provider Business Mailing Address
First Line	:	1297 GRAND AVE # A
Second Line	:
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-1438
Country	:	US
Telephone Number	:	516-272-7990
Fax Number	:	516-272-7995

Provider Business Practice Location Address
First Line	:	1297 GRAND AVE # A
Second Line	:
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-1438
Country	:	US
Telephone Number	:	516-272-7990
Fax Number	:	516-272-7995

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL RAKHAMIMOV
Credential	:
Telephone Number	:	347-803-9494

Provider Enumeration Date	:	05/24/2024
Last Update Date	:	05/29/2024

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