Organization
HEALTHSOURCE PHARMACY IV, LLC
Active
Other names
HealthSource Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BORIS NIYAZOV (MEMBER)
(917) 482-1154
Entity
Organization
Contact information
Practice address
750 COLUMBUS AVE, NEW YORK, NY 10025-6464
(212) 932-0200
(212) 932-0202
Mailing address
750 COLUMBUS AVENUE, NEW YORK, NY 10025
(212) 932-0200
(212) 932-0202
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
035496
NY
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2169943
PK
—
Enumeration date
06/19/2017
Last updated
06/19/2017
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
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