Provider Demographics
NPI:1598595282
Name:PRESTIGE RX LLC
Entity type:Organization
Organization Name:PRESTIGE RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALIM
Authorized Official - Middle Name:
Authorized Official - Last Name:FAOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-442-2705
Mailing Address - Street 1:858 DEKALB AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-1402
Mailing Address - Country:US
Mailing Address - Phone:646-517-0370
Mailing Address - Fax:646-517-0372
Practice Address - Street 1:858 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-1402
Practice Address - Country:US
Practice Address - Phone:646-517-0370
Practice Address - Fax:646-517-0372
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESTIGE RX LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy