Provider Demographics
NPI:1760221196
Name:ENERGIZEDHEALTH RX INC
Entity type:Organization
Organization Name:ENERGIZEDHEALTH RX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAKHAMIMOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-803-9494
Mailing Address - Street 1:1297 GRAND AVE # A
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1438
Mailing Address - Country:US
Mailing Address - Phone:516-272-7990
Mailing Address - Fax:516-272-7995
Practice Address - Street 1:1297 GRAND AVE # A
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-1438
Practice Address - Country:US
Practice Address - Phone:516-272-7990
Practice Address - Fax:516-272-7995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-24
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy