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NPI Code Detail

MEDICARE: YG PHARMACY CORP

MEDICARE: YG PHARMACY 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
13336C0003XCommunity/Retail Pharmacy030896NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15803691OTHERNCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number : 1528345824
Entity Type Code : Organization
Provider Name (Legal Business Name) : YG PHARMACY CORP
Provider Business Mailing Address
First Line : 86-12BB 37TH AVE
Second Line :
City : JACKSON HEIGHTS
State : NY
Zip : 11372
Country : US
Telephone Number : 718-803-3888
Fax Number : 718-803-3887
Provider Business Practice Location Address
First Line : 8612 37TH AVE
Second Line :
City : JACKSON HEIGHTS
State : NY
Zip : 11372-7533
Country : US
Telephone Number : 718-803-3888
Fax Number : 718-803-3887
Authorized Official
Title or Position : PRESIDENT
Name : YEVA GADAYEVA
Credential :
Telephone Number : 718-803-3888
Provider Enumeration Date : 11/15/2011
Last Update Date : 11/15/2011

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