Healthcare Provider Details

I. General information

NPI: 1184629354
Provider Name (Legal Business Name): SBC RX INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 RICHARDS ST
BROOKLYN NY
11231-1635
US

IV. Provider business mailing address

120 RICHARDS ST
BROOKLYN NY
11231-1635
US

V. Phone/Fax

Practice location:
  • Phone: 718-852-0269
  • Fax: 718-852-6429
Mailing address:
  • Phone: 718-852-0269
  • Fax: 718-852-6429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number018238
License Number StateNY

VIII. Authorized Official

Name: ALEX PERCHUK
Title or Position: CORPORATE SECRETARY
Credential: RPH
Phone: 718-835-2000