=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356971774
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL RX PHARMACY CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2020
-----------------------------------------------------
Last Update Date | 01/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13850 84TH DR
-----------------------------------------------------
City | BRIARWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11435-1840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-223-4593
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15316 77TH AVE
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11367-3128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-575-2728
-----------------------------------------------------
Fax | 718-223-4594
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SUPERVISING PHARMACIST/OWNER
-----------------------------------------------------
Name | LARISA NATANOV
-----------------------------------------------------
Credential | PHARM.D
-----------------------------------------------------
Telephone | 917-575-2728
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------