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General NPI Number Information
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NPI Number | 1972212918
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Entity Type | Organization
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Legal Business Name | PUTNAM RX INC
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Dates
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Enumeration Date | 11/17/2022
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Last Update Date | 11/17/2022
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Provider Practice Location Address
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Address Line | 6097 PUTNAM AVE
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City | RIDGEWOOD
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State | NY
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Zip | 11385-4529
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Country | US
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Telephone | 347-763-0033
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Fax | 347-763-0062
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Provider Business Mailing Address
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Address Line | 6097 PUTNAM AVE
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City | RIDGEWOOD
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State | NY
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Zip | 11385-4529
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Country | US
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Telephone | 347-763-0033
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Fax | 347-763-0062
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Authorized Official
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Title or Position | OWNER
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Name | MS. ELANA MATATOV
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Credential |
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Telephone | 347-510-2484
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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 |
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License Number State |
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