Healthcare Provider Details

I. General information

NPI: 1760797534
Provider Name (Legal Business Name): EZ RX PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2010
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8802 4TH AVE
BROOKLYN NY
11209-5606
US

IV. Provider business mailing address

8802 4TH AVE
BROOKLYN NY
11209-5606
US

V. Phone/Fax

Practice location:
  • Phone: 347-560-6560
  • Fax: 347-560-6562
Mailing address:
  • Phone: 347-560-6560
  • Fax: 347-560-6562

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 TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number030240
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ABDELMEZ ALILEALA
Title or Position: OWNER-SP PHARMAXIST-OFFICER
Credential:
Phone: 347-560-6560