Healthcare Provider Details

I. General information

NPI: 1184382749
Provider Name (Legal Business Name): OPRX #11358, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 FRANCIS LEWIS BLVD
FLUSHING NY
11358-1955
US

IV. Provider business mailing address

3515 FRANCIS LEWIS BLVD
FLUSHING NY
11358-1955
US

V. Phone/Fax

Practice location:
  • Phone: 718-539-7559
  • Fax: 718-539-7752
Mailing address:
  • Phone: 718-539-7752
  • Fax: 718-445-8250

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: AUTHORIZED OFFICIAL
Credential:
Phone: 516-876-0737