Provider Demographics
NPI:1124723598
Name:79 EXPRESSRX INC
Entity type:Organization
Organization Name:79 EXPRESSRX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISAK
Authorized Official - Middle Name:
Authorized Official - Last Name:AMINOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-983-1588
Mailing Address - Street 1:7963A MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7451
Mailing Address - Country:US
Mailing Address - Phone:347-983-1588
Mailing Address - Fax:718-223-4873
Practice Address - Street 1:7963A MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7451
Practice Address - Country:US
Practice Address - Phone:347-983-1588
Practice Address - Fax:718-223-4873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy