# MEDI-SPACE PHARMA INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MEDI-SPACE DRUGS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003108663
- **Authorized official:** HILTON CHEUNG (PRESIDENT)
- **Authorized official phone:** (718) 961-3373

## Contact information

- **Practice address:** 4139 MAIN ST, FLUSHING, NY 11355-3132
- **Practice address phone:** (718) 961-3373
- **Practice address fax:** (718) 961-3311
- **Mailing address:** 4139 MAIN ST, FLUSHING, NY 11355-3132
- **Mailing address phone:** (718) 961-3373
- **Mailing address fax:** (718) 961-3311

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 030843 | NY | Yes |

## Other

- **Enumeration date:** 05/13/2011
- **Last updated:** 06/06/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1003108663 | — | NY |
| 05 | — | 3338492 | — | NY |
| 01 | — | 5803918 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |