Healthcare Provider Details

I. General information

NPI: 1255583928
Provider Name (Legal Business Name): ELMHURST RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 E 169TH ST
BRONX NY
10456-2625
US

IV. Provider business mailing address

557 E 169TH ST
BRONX NY
10456-2625
US

V. Phone/Fax

Practice location:
  • Phone: 347-918-8700
  • Fax: 347-918-8701
Mailing address:
  • Phone: 347-918-8700
  • Fax: 347-918-8701

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 TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number029136
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: IMRAN KAZMI
Title or Position: PRESIDENT
Credential:
Phone: 917-449-0086