Healthcare Provider Details

I. General information

NPI: 1326600032
Provider Name (Legal Business Name): PRIME RX SPECIALTY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2773 3RD AVE
BRONX NY
10455-4069
US

IV. Provider business mailing address

2773 3RD AVE
BRONX NY
10455-4069
US

V. Phone/Fax

Practice location:
  • Phone: 718-292-4139
  • Fax:
Mailing address:
  • Phone: 718-292-4139
  • 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: KEVIN Y LEE
Title or Position: PIC
Credential:
Phone: 718-292-4139