MEDICARE: PRIME WELL PHARMACY INC.

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
2	333600000X	Pharmacy

General Provider Information

NPI Number	:	1629932561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME WELL PHARMACY INC.

Provider Business Mailing Address
First Line	:	1207 ASTORIA BLVD
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11102-4179
Country	:	US
Telephone Number	:	347-507-0518
Fax Number	:	347-507-0519

Provider Business Practice Location Address
First Line	:	1207 ASTORIA BLVD
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11102-4179
Country	:	US
Telephone Number	:	347-507-0518
Fax Number	:	347-507-0519

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	ARIEL LEVY
Credential	:
Telephone Number	:	718-308-5060

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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