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Organization
VIDA MAS PHARMACIA INC
Active
Organization
VIDA MAS PHARMACIA INC
Active
Other names
VIDA MAS FARMACIA
Organization subpart
No
Provider details
NPI number
Authorized official
ROSHEL SIONOV (PRESIDENT)
(631) 435-7979
Entity
Organization
Contact information
Practice address
63 WICKS RD, BRENTWOOD, NY 11717-3523
(631) 435-7979
(631) 435-7978
Mailing address
63 WICKS RD, BRENTWOOD, NY 11717-3523
(631) 435-7979
(631) 435-7978
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
039147
STATE BOARD
NY
Enumeration date
04/27/2022
Last updated
05/23/2024
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