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General NPI Number Information
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NPI Number | 1568403467
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Entity Type | Organization
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Legal Business Name | SUPER RX PHARMACY INC
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 03/09/2015
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Provider Practice Location Address
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Address Line | 112 12 LIBERTY AVE
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City | RICHMOND HILL
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State | NY
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Zip | 11419
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Country | US
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Telephone | 718-845-3540
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Fax | 718-845-3625
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Provider Business Mailing Address
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Address Line | 112 12 LIBERTY AVE
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City | RICHMOND HILL
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State | NY
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Zip | 11419
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Country | US
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Telephone | 718-845-3540
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Fax | 718-845-3625
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Authorized Official
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Title or Position | OWNER/SECRETARY
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Name | JOSEPH SWAMI
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Credential |
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Telephone | 718-845-3540
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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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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 027533
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License Number State | NY
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