Organization
ALL-SOURCE CORP
Active
Other names
All-Source Pharmacy & Surgical
Organization subpart
No
Provider details
NPI number
Authorized official
PETER NYAZOV (PRESIDENT)
(718) 255-6100
Entity
Organization
Contact information
Practice address
9109 63RD DR, REGO PARK, NY 11374-3849
(718) 255-6100
(718) 255-6104
Mailing address
9109 63RD DR, REGO PARK, NY 11374-3849
(718) 255-6100
(718) 255-6104
Taxonomy
Speciality
Code
Description
License number
State
332000000X
Military/U.S. Coast Guard Pharmacy
—
—
332100000X
Department of Veterans Affairs (VA) Pharmacy
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
031371
NY
3336C0004X
Compounding Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2135875
PK
—
Enumeration date
07/06/2012
Last updated
09/19/2025
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