MEDICARE: LEADER RX PHARMACY 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	:	1700501681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEADER RX PHARMACY LLC

Provider Business Mailing Address
First Line	:	6346 108TH ST
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-1350
Country	:	US
Telephone Number	:	718-304-1550
Fax Number	:	718-304-1551

Provider Business Practice Location Address
First Line	:	6346 108TH ST
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-1350
Country	:	US
Telephone Number	:	718-340-1550
Fax Number	:	718-340-1551

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	IGOR ARONOV
Credential	:
Telephone Number	:	718-304-1550

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	01/17/2023

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Directions to “LEADER RX PHARMACY LLC ” Practice Location

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