Healthcare Provider Details

I. General information

NPI: 1629538020
Provider Name (Legal Business Name): PHARMAHOUSERX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5411 18TH AVE
BROOKLYN NY
11204-1928
US

IV. Provider business mailing address

5411 18TH AVE
BROOKLYN NY
11204-1928
US

V. Phone/Fax

Practice location:
  • Phone: 718-331-3600
  • Fax:
Mailing address:
  • Phone: 718-502-6872
  • Fax: 718-502-6873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DINARA SHERMUKHAMEDOVA
Title or Position: OWNER
Credential:
Phone: 718-502-6872