Provider Demographics
NPI:1053903104
Name:BLEND LABS RX, LLC.
Entity type:Organization
Organization Name:BLEND LABS RX, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-745-7500
Mailing Address - Street 1:11502 LIBERTY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-1938
Mailing Address - Country:US
Mailing Address - Phone:914-745-7400
Mailing Address - Fax:
Practice Address - Street 1:11502 LIBERTY AVE STE 200
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-1938
Practice Address - Country:US
Practice Address - Phone:914-745-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY038542OtherNEW YORK STATE LICENSE