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General NPI Number Information
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NPI Number | 1174309850
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Entity Type | Organization
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Legal Business Name | GREAT NECK RX INC.
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Dates
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Enumeration Date | 09/07/2023
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Last Update Date | 05/09/2024
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Provider Practice Location Address
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Address Line | 140A MIDDLE NECK RD
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City | GREAT NECK
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State | NY
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Zip | 11021-1232
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Country | US
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Telephone | 516-304-5648
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Fax |
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Provider Business Mailing Address
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Address Line | 140A MIDDLE NECK RD
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City | GREAT NECK
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State | NY
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Zip | 11021-1232
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. BORIS MAKSUMOV
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Credential |
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Telephone | 954-736-6957
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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