MEDICARE: INVERSA RX PHARMACY LLC

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	:	1235095928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INVERSA RX PHARMACY LLC

Provider Business Mailing Address
First Line	:	418 BROADWAY STE N
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12207-2922
Country	:	US
Telephone Number	:	929-717-4415
Fax Number	:

Provider Business Practice Location Address
First Line	:	3545 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-5705
Country	:	US
Telephone Number	:	914-433-6876
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	HAYWOOD HAWTHORNE
Credential	:
Telephone Number	:	929-417-4415

Provider Enumeration Date	:	12/26/2025
Last Update Date	:	06/12/2026

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Directions to “INVERSA RX PHARMACY LLC ” Practice Location

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