Healthcare Provider Details

I. General information

NPI: 1679285340
Provider Name (Legal Business Name): OPRX 11514 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401B OLD COUNTRY RD
CARLE PLACE NY
11514-2122
US

IV. Provider business mailing address

401B OLD COUNTRY RD
CARLE PLACE NY
11514-2122
US

V. Phone/Fax

Practice location:
  • Phone: 516-340-4733
  • Fax: 516-340-4473
Mailing address:
  • Phone: 516-340-4733
  • Fax: 516-340-4473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SARIT ROY
Title or Position: MANAGING MEMBER
Credential:
Phone: 516-876-0737