Healthcare Provider Details

I. General information

NPI: 1225070857
Provider Name (Legal Business Name): RG DRUG CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 09/19/2025
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2191 BROADWAY
NEW YORK NY
10024-6611
US

IV. Provider business mailing address

2191 BROADWAY
NEW YORK NY
10024-6611
US

V. Phone/Fax

Practice location:
  • Phone: 212-877-3480
  • Fax: 212-769-9095
Mailing address:
  • Phone: 212-877-3480
  • Fax: 212-769-9095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number28RO00042200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number021514
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPCN.0000753
License Number StateCT

VIII. Authorized Official

Name: RUSSELL GELLIS
Title or Position: PRESIDENT
Credential: RPH
Phone: 917-578-4835