Healthcare Provider Details

I. General information

NPI: 1629932561
Provider Name (Legal Business Name): PRIME WELL PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 ASTORIA BLVD
ASTORIA NY
11102-4179
US

IV. Provider business mailing address

1207 ASTORIA BLVD
ASTORIA NY
11102-4179
US

V. Phone/Fax

Practice location:
  • Phone: 347-507-0518
  • Fax: 347-507-0519
Mailing address:
  • Phone: 347-507-0518
  • Fax: 347-507-0519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: ARIEL LEVY
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 718-308-5060