Healthcare Provider Details

I. General information

NPI: 1336686179
Provider Name (Legal Business Name): 110RXCORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 E 110TH ST
NEW YORK NY
10029-8054
US

IV. Provider business mailing address

127 E 110TH ST
NEW YORK NY
10029-8054
US

V. Phone/Fax

Practice location:
  • Phone: 212-996-0055
  • Fax:
Mailing address:
  • Phone: 212-996-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DINA POMERANETS
Title or Position: PRESIDENT
Credential:
Phone: 212-996-0055