Healthcare Provider Details

I. General information

NPI: 1801252382
Provider Name (Legal Business Name): CITIHEALTH RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 COURT ST
NEWARK NJ
07102-2693
US

IV. Provider business mailing address

23 COURT STREET
NEWARK NJ
07102
US

V. Phone/Fax

Practice location:
  • Phone: 862-772-0442
  • Fax: 973-732-5504
Mailing address:
  • Phone: 862-772-0442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number28RS00746400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MEYER DAVYDOV
Title or Position: PRESIDENT
Credential:
Phone: 347-437-9341