Provider Demographics
NPI:1730975681
Name:FREEPORT RX INC
Entity type:Organization
Organization Name:FREEPORT RX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAIMOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-352-0151
Mailing Address - Street 1:132 W SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3521
Mailing Address - Country:US
Mailing Address - Phone:646-352-0151
Mailing Address - Fax:646-352-0116
Practice Address - Street 1:132 W SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3521
Practice Address - Country:US
Practice Address - Phone:646-352-0151
Practice Address - Fax:646-352-0116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy