Provider Demographics
NPI:1902616485
Name:NEW HAVEN RX LLC
Entity type:Organization
Organization Name:NEW HAVEN RX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-216-0695
Mailing Address - Street 1:P.O. BOX 186
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:WV
Mailing Address - Zip Code:25265-0000
Mailing Address - Country:US
Mailing Address - Phone:239-216-0695
Mailing Address - Fax:832-218-1801
Practice Address - Street 1:307 5TH STREET
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:WV
Practice Address - Zip Code:25265-0000
Practice Address - Country:US
Practice Address - Phone:239-216-0695
Practice Address - Fax:832-218-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy