Provider Demographics
NPI:1780425348
Name:STUYTOWN RX, LLC
Entity type:Organization
Organization Name:STUYTOWN RX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROZA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAKUBOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-605-7527
Mailing Address - Street 1:329 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4228
Mailing Address - Country:US
Mailing Address - Phone:646-838-3850
Mailing Address - Fax:212-208-2574
Practice Address - Street 1:329 E 14TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4228
Practice Address - Country:US
Practice Address - Phone:646-838-3850
Practice Address - Fax:212-208-2574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy