MEDICARE: OLD FASHIONED RX 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	:	1588547335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLD FASHIONED RX LLC

Provider Business Mailing Address
First Line	:	1019 FORT SALONGA RD STE 102
Second Line	:
City	:	NORTHPORT
State	:	NY
Zip	:	11768-2270
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1019 FORT SALONGA RD STE 102
Second Line	:
City	:	NORTHPORT
State	:	NY
Zip	:	11768-2270
Country	:	US
Telephone Number	:	516-802-5992
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEVEN ZACHARIADIS
Credential	:
Telephone Number	:	516-805-5992

Provider Enumeration Date	:	07/29/2025
Last Update Date	:	07/29/2025

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Directions to “OLD FASHIONED RX LLC ” Practice Location

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