MEDICARE: PMY, LLC

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

General Provider Information

NPI Number	:	1285394940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PMY, LLC

Provider Business Mailing Address
First Line	:	419 FOREST AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-2623
Country	:	US
Telephone Number	:	917-444-1588
Fax Number	:	917-444-1589

Provider Business Practice Location Address
First Line	:	419 FOREST AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10301-2623
Country	:	US
Telephone Number	:	917-444-1588
Fax Number	:	917-444-1589

Authorized Official
Title or Position	:	OWNER
Name	:	ABDUSOBIRJON UTAMISHEV
Credential	:
Telephone Number	:	917-444-1588

Provider Enumeration Date	:	12/22/2021
Last Update Date	:	06/03/2026

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Directions to “PMY, LLC ” Practice Location

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