Provider Demographics
NPI:1902567738
Name:OPRX #11776, LLC
Entity Type:Organization
Organization Name:OPRX #11776, LLC
Other - Org Name:ONPOINT PHARMACY OF PORT JEFFERSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SARIT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-876-0737
Mailing Address - Street 1:4747 NESCONSET HWY UNIT 10
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-2866
Mailing Address - Country:US
Mailing Address - Phone:631-474-7828
Mailing Address - Fax:631-474-7871
Practice Address - Street 1:4747 NESCONSET HWY UNIT 10
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2866
Practice Address - Country:US
Practice Address - Phone:631-474-7828
Practice Address - Fax:631-474-7871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07741106Medicaid