Provider Demographics
NPI:1871131441
Name:WONDERFUL RX PHARMACY INC
Entity type:Organization
Organization Name:WONDERFUL RX PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:HAO
Authorized Official - Middle Name:
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:516-416-4881
Mailing Address - Street 1:52 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2938
Mailing Address - Country:US
Mailing Address - Phone:516-416-4881
Mailing Address - Fax:
Practice Address - Street 1:52 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2938
Practice Address - Country:US
Practice Address - Phone:516-416-4881
Practice Address - Fax:516-416-4883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-14
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy