=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003569997
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARX PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2022
-----------------------------------------------------
Last Update Date | 12/04/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 316 BRADLEY AVE
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10314-5171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-971-1766
-----------------------------------------------------
Fax | 718-971-1879
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 316 BRADLEY AVE
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10314-5171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-971-1766
-----------------------------------------------------
Fax | 718-971-1879
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SUPERVISING PHARMACIST
-----------------------------------------------------
Name | JASON TORJESEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-971-1766
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------