Organization
MANSON PHARMACY INC
Active
Other names
MANSON PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
OLGA YASHAYEVA (SUPERVISING PHARMACIST)
(718) 297-4424
Entity
Organization
Contact information
Practice address
13769 QUEENS BLVD, BRIARWOOD, NY 11435-1845
(718) 297-4424
(718) 526-6104
Mailing address
13769 QUEENS BLVD, BRIARWOOD, NY 11435-1845
(718) 297-4424
(718) 526-6104
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
035082
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04640048
—
NY
01
—
2167112
PK
—
Enumeration date
10/19/2016
Last updated
04/28/2022
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