Organization
HEALTHSOURCE PHARMACY III INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BORIS NIYAZOV R.PH, MBA (PRESIDENT)
(212) 794-8700
Entity
Organization
Contact information
Practice address
235 E 57TH ST, NEW YORK, NY 10022-2842
(212) 310-0111
(212) 310-0144
Mailing address
235 E 57TH ST, NEW YORK, NY 10022-2842
(212) 310-0111
(212) 310-0144
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
027524
NY
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02748745
—
NY
01
—
3348679
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/30/2006
Last updated
02/25/2008
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