# 63RD RX CORP.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639819444
- **Authorized official:** MICHAEL KAKZANOV (PRESIDENT)
- **Authorized official phone:** (718) 897-4747

## Contact information

- **Practice address:** 9855 63RD RD, REGO PARK, NY 11374-1739
- **Practice address phone:** (718) 897-4747
- **Practice address fax:** (718) 897-4748
- **Mailing address:** 9855 63RD RD, REGO PARK, NY 11374-1739
- **Mailing address phone:** (718) 897-4747
- **Mailing address fax:** (718) 897-4748

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 03/30/2022
- **Last updated:** 10/23/2023