Healthcare Provider Details

I. General information

NPI: 1275442089
Provider Name (Legal Business Name): INVERSA RX PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 WHITE PLAINS RD
BRONX NY
10467-5705
US

IV. Provider business mailing address

3545 WHITE PLAINS RD
BRONX NY
10467-5705
US

V. Phone/Fax

Practice location:
  • Phone: 929-717-4415
  • Fax: 929-717-5168
Mailing address:
  • Phone: 929-717-4415
  • Fax: 929-717-5168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. HAYWOOD HAWTHORNE
Title or Position: OWNER & MANAGING MEMBER
Credential:
Phone: 914-433-6876