Healthcare Provider Details

I. General information

NPI: 1467874339
Provider Name (Legal Business Name): CVS RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 09/19/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9914 63RD RD
REGO PARK NY
11374-1940
US

IV. Provider business mailing address

99-14 63RD ROAD
REGO PARK NY
11374
US

V. Phone/Fax

Practice location:
  • Phone: 718-997-7444
  • Fax: 718-997-7445
Mailing address:
  • Phone: 718-997-7444
  • Fax: 718-997-7445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number032586
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2145106
Identifier TypeOTHER
Identifier State
Identifier IssuerPK
# 2
Identifier03874884
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: BORIS KANDOV
Title or Position: OWNER
Credential:
Phone: 718-997-7444