MEDICARE: MAGNET 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	:	1619566411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAGNET RX LLC

Provider Business Mailing Address
First Line	:	7702 21ST AVE
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-1219
Country	:	US
Telephone Number	:	718-728-6878
Fax Number	:	718-728-6843

Provider Business Practice Location Address
First Line	:	7702 21ST AVE
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-1219
Country	:	US
Telephone Number	:	718-728-6878
Fax Number	:	718-728-6843

Authorized Official
Title or Position	:	OWNER
Name	:	SIMON KALANTAROV
Credential	:
Telephone Number	:	718-728-6878

Provider Enumeration Date	:	01/15/2021
Last Update Date	:	01/15/2021

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Directions to “MAGNET RX LLC ” Practice Location

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