Provider Demographics
NPI:1992117451
Name:MODERN RX LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:MODERN RX LIMITED LIABILITY COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST/AO
Authorized Official - Prefix:
Authorized Official - First Name:KLARA
Authorized Official - Middle Name:
Authorized Official - Last Name:REIZIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-217-3908
Mailing Address - Street 1:33-41 NEWARK ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5620
Mailing Address - Country:US
Mailing Address - Phone:201-420-9000
Mailing Address - Fax:201-420-4040
Practice Address - Street 1:33-41 NEWARK ST STE 2B
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5620
Practice Address - Country:US
Practice Address - Phone:201-420-9000
Practice Address - Fax:201-420-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X, 3336S0011X
NJ28RS007334003336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146077OtherPK
NJ0436755Medicaid