Healthcare Provider Details

I. General information

NPI: 1154056851
Provider Name (Legal Business Name): OPRX #11577, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 ROSLYN RD
ROSLYN HEIGHTS NY
11577-2214
US

IV. Provider business mailing address

310 ROSLYN RD
ROSLYN HEIGHTS NY
11577-2214
US

V. Phone/Fax

Practice location:
  • Phone: 516-621-7373
  • Fax: 516-621-5323
Mailing address:
  • Phone: 516-621-7373
  • Fax: 516-621-5323

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 Number
License Number State

VIII. Authorized Official

Name: SARIT ROY
Title or Position: MEMBER
Credential:
Phone: 516-876-0737