MEDICARE: FILL MEDS 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	333600000X	Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	038909	OTHER	NY	PHARMACY REGISTRATION

General Provider Information

NPI Number	:	1568129641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FILL MEDS RX INC.

Provider Business Mailing Address
First Line	:	1626 NEW YORK AVE
Second Line	:
City	:	HUNTINGTON STATION
State	:	NY
Zip	:	11746-2418
Country	:	US
Telephone Number	:	631-424-3903
Fax Number	:	631-424-3904

Provider Business Practice Location Address
First Line	:	1626 NEW YORK AVE
Second Line	:
City	:	HUNTINGTON STATION
State	:	NY
Zip	:	11746-2418
Country	:	US
Telephone Number	:	631-424-3903
Fax Number	:	631-424-3904

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SEMEN MURATOV
Credential	:
Telephone Number	:	631-424-3903

Provider Enumeration Date	:	11/23/2021
Last Update Date	:	03/08/2023

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