Healthcare Provider Details

I. General information

NPI: 1366351793
Provider Name (Legal Business Name): CRESCENT ORGANIX PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2914 CRESCENT ST
ASTORIA NY
11102-3140
US

IV. Provider business mailing address

2914 CRESCENT ST
ASTORIA NY
11102-3140
US

V. Phone/Fax

Practice location:
  • Phone: 347-639-0010
  • Fax: 347-639-0014
Mailing address:
  • Phone: 347-639-0010
  • Fax: 347-639-0014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ALLA ZAVULUNOVA
Title or Position: OWNER
Credential:
Phone: 347-639-0010