Healthcare Provider Details

I. General information

NPI: 1932997657
Provider Name (Legal Business Name): AEGIS RX PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2418 GRAND AVE
BALDWIN NY
11510-3220
US

IV. Provider business mailing address

2418 GRAND AVE
BALDWIN NY
11510-3220
US

V. Phone/Fax

Practice location:
  • Phone: 516-500-2293
  • Fax: 516-268-9358
Mailing address:
  • Phone: 516-500-2293
  • Fax: 516-268-9358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: GABRIEL LOPES TEIXEIRA
Title or Position: CEO / PRESIDENT / OWNER
Credential:
Phone: 516-500-2293