Phoenix Specialty Pharmacy Corp

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PHOENIX SPECIALTY PHARMACY CORP

Doing business as

Phoenix RX

Practice address

4100 Park Ave
Weehawken, NJ 07086-6196

Phone

(201) 453-3114

Fax

(877) 811-1227

NPI assigned

Nov 16, 2023

Organization subpart

No

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

Authorized official

Name

Natavan Nasirov

Title

President

Phone

(201) 453-3114

Specialties & licenses 1

Addresses

Other names 1

• PHOENIX RX Doing business as

Medicare fee-for-service enrollment

Enrolled in NJ2 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": "1700092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1811762131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 PARK AVE",
            "city": "WEEHAWKEN",
            "state": "NJ",
            "postal_code": "070866132",
            "telephone_number": "201-453-3114",
            "fax_number": "877-811-1227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 PARK AVE",
            "city": "WEEHAWKEN",
            "state": "NJ",
            "postal_code": "070866196",
            "telephone_number": "201-453-3114",
            "fax_number": "877-811-1227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX SPECIALTY PHARMACY CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-16",
        "last_updated": "2025-09-11",
        "certification_date": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "NASIROV",
        "authorized_official_first_name": "NATAVAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-453-3114"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHOENIX RX",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PHOENIX RX",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Weehawken, NJ
• Providers in Weehawken, NJ by specialty
• Community/Retail Pharmacy in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 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.