Organization
HEALTHSOURCE PHARMACY INC
Active
Other names
HEALTHSOURCE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
BORIS NIYAZOV (PRESIDENT)
(212) 794-8700
Entity
Organization
Contact information
Practice address
1296 2ND AVE, NEW YORK, NY 10065-5707
(212) 794-8700
(212) 794-4979
Mailing address
1302 2ND AVE, NEW YORK, NY 10065-5706
(212) 794-8700
(212) 794-4979
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
025135
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02182694
—
NY
01
—
2063440
PK
—
Enumeration date
08/31/2006
Last updated
04/27/2022
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