Organization
MEDISOURCE PHARMACY LLC
Active
Other names
Medisource Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ROZA DAVIDOV (OWNER)
(516) 615-2974
Entity
Organization
Contact information
Practice address
720 OLD COUNTRY RD, PLAINVIEW, NY 11803-4929
(516) 605-0080
(516) 605-0077
Mailing address
720 OLD COUNTRY RD, PLAINVIEW, NY 11803-4929
(516) 605-0080
(516) 605-0077
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
028939
NY
3336C0003X
Community/Retail Pharmacy
—
—
3336S0011X
Specialty Pharmacy
Primary
028939
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2070643
PK
—
05
—
3016644
—
NY
Enumeration date
06/16/2008
Last updated
01/27/2026
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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