Healthcare Provider Details

I. General information

NPI: 1285944744
Provider Name (Legal Business Name): KINGDOM RX CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 E TREMONT AVE
BRONX NY
10461-5719
US

IV. Provider business mailing address

3131 E TREMONT AVE
BRONX NY
10461-5719
US

V. Phone/Fax

Practice location:
  • Phone: 718-822-5900
  • Fax: 718-822-5909
Mailing address:
  • Phone: 718-822-5900
  • Fax: 718-822-5909

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 Code333600000X
TaxonomyPharmacy
License Number030359
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: YITZCHOK SULIMANOV
Title or Position: PHARMACIST/OWNER
Credential: PHARMD
Phone: 917-455-6788