Healthcare Provider Details

I. General information

NPI: 1235095928
Provider Name (Legal Business Name): INVERSA RX PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2025
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 WHITE PLAINS RD
BRONX NY
10467-5705
US

IV. Provider business mailing address

418 BROADWAY STE N
ALBANY NY
12207-2922
US

V. Phone/Fax

Practice location:
  • Phone: 914-433-6876
  • Fax:
Mailing address:
  • Phone: 914-433-6876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. HAYWOOD HAWTHORNE
Title or Position: CEO
Credential:
Phone: 914-433-6876