=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891522462
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CASCADE RX LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2024
-----------------------------------------------------
Last Update Date | 04/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 859 MYRTLE AVE GROUND FL UNIT 1
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-500-3307
-----------------------------------------------------
Fax | 347-229-1948
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 859 MYRTLE AVE GROUND FL UNIT 1
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ALBERT ZIBAK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-500-3307
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------