MEDICARE: APOLLO PHARMACY 2.0 CORP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	041861	OTHER	NY	STATEBOARD

General Provider Information

NPI Number	:	1093506289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APOLLO PHARMACY 2.0 CORP.

Provider Business Mailing Address
First Line	:	2255 ADAM CLAYTON POWELL JR BLVD
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-7807
Country	:	US
Telephone Number	:	917-477-3472
Fax Number	:	917-672-3494

Provider Business Practice Location Address
First Line	:	2255 ADAM CLAYTON POWELL JR BLVD
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-7807
Country	:	US
Telephone Number	:	917-477-3472
Fax Number	:	917-672-3494

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHAMUEL RAFAILOV
Credential	:
Telephone Number	:	917-477-3472

Provider Enumeration Date	:	05/15/2025
Last Update Date	:	09/26/2025

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