Healthcare Provider Details

I. General information

NPI: 1962326546
Provider Name (Legal Business Name): PORTWASH RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

664 PORT WASHINGTON BLVD
PORT WASHINGTON NY
11050-3734
US

IV. Provider business mailing address

664 PORT WASHINGTON BLVD
PORT WASHINGTON NY
11050-3734
US

V. Phone/Fax

Practice location:
  • Phone: 516-998-1247
  • Fax: 516-998-1246
Mailing address:
  • Phone: 516-998-1247
  • Fax: 516-998-1246

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: SHAN ASIF
Title or Position: OWNER
Credential:
Phone: 551-482-3920