Healthcare Provider Details

I. General information

NPI: 1003107319
Provider Name (Legal Business Name): MAKSOUD RX CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 2ND AVE
NEW YORK NY
10017-4709
US

IV. Provider business mailing address

800 2ND AVE
NEW YORK NY
10017-4709
US

V. Phone/Fax

Practice location:
  • Phone: 646-918-7363
  • Fax: 646-918-7336
Mailing address:
  • Phone: 646-918-7363
  • Fax: 646-918-7336

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 Number030598
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HOSSAM MAKSOUD
Title or Position: PRESIDENT
Credential: PHARMACY
Phone: 646-918-7363