Organization
MAIN SOURCE PHARMACY INC
Active
Other names
Main Source Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
SVETLANA NIYAZOVA (OWNER,RPH,AO)
(631) 760-1114
Entity
Organization
Contact information
Practice address
347 MAIN ST, HUNTINGTON, NY 11743-6914
(631) 760-1114
(631) 760-1035
Mailing address
347B MAIN ST, HUNTINGTON, NY 11743-6914
(631) 760-1114
(631) 760-1035
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
036497
NY
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2176773
PK
—
Enumeration date
03/27/2018
Last updated
09/17/2018
About Stedi
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