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General NPI Number Information
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NPI Number | 1144580705
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Entity Type | Organization
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Legal Business Name | DIRECT RX PHARMACY INC
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 10205 JAMAICA AVE
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City | RICHMOND HILL
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State | NY
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Zip | 11418-2006
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Country | US
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Telephone | 718-441-4693
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Fax | 718-441-3046
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Provider Business Mailing Address
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Address Line | 10205 JAMAICA AVE
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City | RICHMOND HILL
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State | NY
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Zip | 11418-2010
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Country | US
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Telephone | 718-441-4693
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Fax | 718-441-3046
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Authorized Official
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Title or Position | PRESIDENT
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Name | MOSHE MAVLYANOV
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Credential |
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Telephone | 718-441-4693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 032058
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License Number State | NY
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