Organization
DERIS PHARMACY INC
Active
Other names
BELL BOULEVARD PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
GENNADIY ABDURAKHMANOV (PRESIDENT)
(718) 229-2344
Entity
Organization
Contact information
Practice address
4748 BELL BLVD, BAYSIDE, NY 11361-3334
(718) 229-2344
(718) 717-0004
Mailing address
4748 BELL BLVD, BAYSIDE, NY 11361-3334
(718) 229-2344
(718) 717-0004
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
020200
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01126154
—
NY
01
—
2066412
PK
—
Enumeration date
07/30/2006
Last updated
04/16/2026
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