Healthcare Provider Details

I. General information

NPI: 1013820489
Provider Name (Legal Business Name): MERRICK RX PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3381 MERRICK RD STE D
WANTAGH NY
11793-4342
US

IV. Provider business mailing address

3381 MERRICK RD STE D
WANTAGH NY
11793-4342
US

V. Phone/Fax

Practice location:
  • Phone: 929-257-8163
  • Fax: 929-257-8163
Mailing address:
  • Phone: 929-257-8163
  • Fax: 929-257-8163

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: MUJAHID ALI SHAH
Title or Position: OWNER
Credential:
Phone: 929-257-8163