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Contact Information

63RD DRIVE RX, INC.
9418 ROOSEVELT AVE # 11C11D
JACKSON HEIGHTS, NY11372-7916
 Phone: 718-440-4917
 Fax: 888-654-4334
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Long Term Care Pharmacy

3336L0003X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for 63RD DRIVE RX, INC.

NPI Number 1285451161
LBN Legal business name 63RD DRIVE RX, INC.
Authorized official DMITRIY EVTYUSHKIN - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 09/23/2024
Last updated 09/23/2024 - More than a year ago
Identifiers
NY Other 039844 NY STATE BOARD LICENSE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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