Healthcare Provider Details

I. General information

NPI: 1629722814
Provider Name (Legal Business Name): DAILY DOSE RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 BROADWAY
BROOKLYN NY
11206-7303
US

IV. Provider business mailing address

6441 SAUNDERS ST APT 306
REGO PARK NY
11374-3225
US

V. Phone/Fax

Practice location:
  • Phone: 718-908-0200
  • Fax:
Mailing address:
  • Phone: 718-791-0227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. ILYEVU ELE KALONTAROV
Title or Position: CEO/SUPERVISING PHARMACIST
Credential:
Phone: 718-791-0227