Queens Blvd RX Corp.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

QUEENS BLVD RX CORP.

Practice address

12084 Queens Blvd
Kew Gardens, NY 11415-1204

Phone

(718) 872-9772

Fax

(646) 813-1803

NPI assigned

Jan 21, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Omar Sultan Ahmadi

Title

Pharmacist

Phone

(718) 872-9772

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• PRIME MED PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in NY2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1737417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759190400000",
    "number": "1689486490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12084 QUEENS BLVD",
            "city": "KEW GARDENS",
            "state": "NY",
            "postal_code": "114151204",
            "telephone_number": "718-872-9772",
            "fax_number": "646-813-1803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12084 QUEENS BLVD",
            "city": "KEW GARDENS",
            "state": "NY",
            "postal_code": "114151204",
            "telephone_number": "718-872-9772",
            "fax_number": "646-813-1803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUEENS BLVD RX CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-21",
        "last_updated": "2025-09-30",
        "certification_date": "2025-09-30",
        "status": "A",
        "authorized_official_last_name": "AHMADI",
        "authorized_official_first_name": "OMAR",
        "authorized_official_middle_name": "SULTAN",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "718-872-9772"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05112818",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PRIME MED PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PRIME MED PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tatyana Pukhovich
• Marni Shannon Purnell, LPN
• Alexa Francia Pyatsky
• Q Pharmacy RX Inc
• Iqra Quddus
• Queens Replacement LLC
• Queens Wellness Inc
• Amy Beth Rachman, MA,CCC-SLP
• Danil Isakovich Rafailov, MD
• Diana Rafailov, MS

• Community/Retail Pharmacy in Kew Gardens, NY
• Providers in Kew Gardens, NY by specialty
• Community/Retail Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.