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General NPI Number Information
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NPI Number | 1760221196
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Entity Type | Organization
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Legal Business Name | ENERGIZEDHEALTH RX INC
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Dates
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Enumeration Date | 05/24/2024
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 1297 GRAND AVE # A
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City | NORTH BALDWIN
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State | NY
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Zip | 11510-1438
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Country | US
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Telephone | 516-272-7990
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Fax | 516-272-7995
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Provider Business Mailing Address
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Address Line | 1297 GRAND AVE # A
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City | NORTH BALDWIN
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State | NY
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Zip | 11510-1438
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Country | US
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Telephone | 516-272-7990
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Fax | 516-272-7995
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL RAKHAMIMOV
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Credential |
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Telephone | 347-803-9494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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