Organization
PEACH TREE PHARMACY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDER LISYANSKY (OWNER)
(908) 320-1027
Entity
Organization
Contact information
Practice address
2492 ADAM CLAYTON POWELL JR BLVD, NEW YORK, NY 10030-1340
(646) 755-8262
(646) 755-8263
Mailing address
2492 ADAM CLAYTON POWELL JR BLVD, NEW YORK, NY 10030-1340
(646) 755-8262
(646) 755-8263
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
039982
NYS BOARD OF PHARMACY
NY
Enumeration date
12/22/2022
Last updated
12/22/2022
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