Provider Demographics
NPI:1336837707
Name:CENTRAL RX 1 INC
Entity type:Organization
Organization Name:CENTRAL RX 1 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NISON
Authorized Official - Middle Name:
Authorized Official - Last Name:KATANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-463-9706
Mailing Address - Street 1:6909 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-6645
Mailing Address - Country:US
Mailing Address - Phone:347-463-9706
Mailing Address - Fax:
Practice Address - Street 1:6909 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-6645
Practice Address - Country:US
Practice Address - Phone:347-463-9706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy