MEDICARE: THRIVE CARE RX INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1053103382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THRIVE CARE RX INC

Provider Business Mailing Address
First Line	:	6404 FRESH POND RD
Second Line	:
City	:	RIDGEWOOD
State	:	NY
Zip	:	11385-3331
Country	:	US
Telephone Number	:	347-987-3031
Fax Number	:	347-987-3032

Provider Business Practice Location Address
First Line	:	6404 FRESH POND RD
Second Line	:
City	:	RIDGEWOOD
State	:	NY
Zip	:	11385-3331
Country	:	US
Telephone Number	:	347-987-3031
Fax Number	:	347-987-3032

Authorized Official
Title or Position	:	OWNER
Name	:	STACYANN A POWELL
Credential	:
Telephone Number	:	347-987-3031

Provider Enumeration Date	:	05/21/2025
Last Update Date	:	05/21/2025

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