Healthcare Provider Details

I. General information

NPI: 1316673536
Provider Name (Legal Business Name): OPRX #11565, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 HEMPSTEAD AVE
MALVERNE NY
11565-2034
US

IV. Provider business mailing address

247 HEMPSTEAD AVE
MALVERNE NY
11565-2034
US

V. Phone/Fax

Practice location:
  • Phone: 516-593-8663
  • Fax: 516-599-8356
Mailing address:
  • Phone: 516-593-8663
  • Fax: 516-599-8356

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: PRESIDENT
Credential:
Phone: 516-876-0737