Provider Demographics
NPI:1689486490
Name:QUEENS BLVD RX CORP.
Entity type:Organization
Organization Name:QUEENS BLVD RX CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMINOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-872-9772
Mailing Address - Street 1:12084 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1204
Mailing Address - Country:US
Mailing Address - Phone:718-872-9772
Mailing Address - Fax:646-813-1803
Practice Address - Street 1:12084 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1204
Practice Address - Country:US
Practice Address - Phone:718-872-9772
Practice Address - Fax:646-813-1803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-21
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy