Organization
MANSON HEALTH INC
Active
Other names
Manson Health Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RADION ISKHAKOV (PRESIDENT)
(718) 880-2844
Entity
Organization
Contact information
Practice address
13807 QUEENS BLVD, BRIARWOOD, NY 11435-2641
(718) 880-2844
Mailing address
13807 QUEENS BLVD, BRIARWOOD, NY 11435-2641
(718) 880-2844
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2166035
PK
—
Enumeration date
11/01/2016
Last updated
11/04/2016
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