Healthcare Provider Details

I. General information

NPI: 1790612463
Provider Name (Legal Business Name): I SAMS RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 E TREMONT AVE
BRONX NY
10457-5001
US

IV. Provider business mailing address

717 E TREMONT AVE
BRONX NY
10457-5001
US

V. Phone/Fax

Practice location:
  • Phone: 718-618-7618
  • Fax: 347-269-5128
Mailing address:
  • Phone: 718-618-7618
  • Fax: 347-269-5128

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: SHAIRYAR KHANKHELL
Title or Position: PRESIDENT
Credential:
Phone: 718-618-7618