# HEALTHSOURCE PHARMACY INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** HEALTHSOURCE PHARMACY INC
- **Other names:** Healthsource Pharmacy
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1679318125
- **Legal business name:** HEALTHSOURCE PHARMACY INC
- **Authorized official:** BORIS NIYAZOV (PRESIDENT)
- **Authorized official phone:** (212) 794-8700

## Contact information

- **Practice address:** 1296 2ND AVE, NEW YORK, NY 10065-5707
- **Practice address phone:** (212) 794-8700
- **Mailing address:** 1296 2ND AVE, NEW YORK, NY 10065-5707

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 06/26/2024
- **Last updated:** 06/26/2024