Provider Demographics
NPI:1902342538
Name:DENISON RX INC.
Entity Type:Organization
Organization Name:DENISON RX INC.
Other - Org Name:DENISON RX INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAVLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRDZELISHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-513-3210
Mailing Address - Street 1:815 E TREMONT AVE
Mailing Address - Street 2:STORE H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-4108
Mailing Address - Country:US
Mailing Address - Phone:718-513-3210
Mailing Address - Fax:718-513-3209
Practice Address - Street 1:815 E TREMONT AVE
Practice Address - Street 2:STORE H
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4108
Practice Address - Country:US
Practice Address - Phone:718-513-3210
Practice Address - Fax:718-513-3209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035099333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167261OtherPK