Healthcare Provider Details

I. General information

NPI: 1174427405
Provider Name (Legal Business Name): 57 RX PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9705 57TH AVE STE 2
CORONA NY
11368-3540
US

IV. Provider business mailing address

97-05 #2 57 AVE
CORONA NY
11368
US

V. Phone/Fax

Practice location:
  • Phone: 718-433-9105
  • Fax: 718-433-9104
Mailing address:
  • Phone: 718-433-9105
  • Fax: 718-433-9104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: DMITRI PYAK
Title or Position: OWNER
Credential:
Phone: 718-433-9105