Provider Demographics
NPI:1366552465
Name:LOCAL RX, INC
Entity type:Organization
Organization Name:LOCAL RX, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:USTAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:RPM
Authorized Official - Phone:718-897-3016
Mailing Address - Street 1:10319 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3447
Mailing Address - Country:US
Mailing Address - Phone:718-897-4888
Mailing Address - Fax:718-897-6057
Practice Address - Street 1:10319 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3447
Practice Address - Country:US
Practice Address - Phone:718-897-4888
Practice Address - Fax:718-897-6057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02183237Medicaid
4277570001Medicare ID - Type Unspecified