Organization
63RD DRIVE RX, INC.
Active
Other names
InterPharm Rx
Organization subpart
No
Provider details
NPI number
Authorized official
DMITRIY EVTYUSHKIN (PRESIDENT)
(718) 440-4917
Entity
Organization
Contact information
Practice address
9418 ROOSEVELT AVE # 11C11D, JACKSON HEIGHTS, NY 11372-7916
(915) 213-8519
Mailing address
9418 ROOSEVELT AVE # 11C11D, JACKSON HEIGHTS, NY 11372-7916
(718) 440-4917
(888) 654-4334
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Enumeration date
09/30/2022
Last updated
09/17/2024
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