Organization
HEALTH SOURCE PLUS PHARMACY, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMMA KALONTAR (PHARMACIST)
(718) 849-6700
Entity
Organization
Contact information
Practice address
11807 METROPOLITAN AVE, KEW GARDENS, NY 11415-2020
(718) 849-6700
(718) 849-1659
Mailing address
11807 METROPOLITAN AVE, KEW GARDENS, NY 11415-2020
(718) 849-6700
(718) 849-1659
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
029701
NY
3336L0003X
Long Term Care Pharmacy
029701
NY
3336S0011X
Specialty Pharmacy
029701
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2122230
PK
—
05
—
3123053
—
NY
Enumeration date
07/22/2009
Last updated
03/29/2017
About Stedi
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