Healthcare Provider Details

I. General information

NPI: 1134673403
Provider Name (Legal Business Name): YESRX PHARMACY CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2016
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2492 WEBSTER AVE
BRONX NY
10458-5509
US

IV. Provider business mailing address

2492 WEBSTER AVE
BRONX NY
10458
US

V. Phone/Fax

Practice location:
  • Phone: 718-367-2105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. STANISLAV SHAMOTA
Title or Position: PRESIDENT
Credential:
Phone: 347-843-2526