MEDICARE: MED RX PHARMACY, 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	3336C0003X	Community/Retail Pharmacy	027045	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780699462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED RX PHARMACY, INC

Provider Business Mailing Address
First Line	:	9727 QUEENS BLVD
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-2103
Country	:	US
Telephone Number	:	718-897-8500
Fax Number	:	718-897-5499

Provider Business Practice Location Address
First Line	:	9727 QUEENS BLVD
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-2103
Country	:	US
Telephone Number	:	718-897-8500
Fax Number	:

Authorized Official
Title or Position	:	SUPERVISING PHARMACIST
Name	:	MS. IZABELLA BINAMINOVA
Credential	:	RPH
Telephone Number	:	718-897-8500

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	06/18/2013

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Directions to “MED RX PHARMACY, INC ” Practice Location

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