Healthcare Provider Details

I. General information

NPI: 1215130992
Provider Name (Legal Business Name): Y S DRUG STORE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13654 39TH AVE
FLUSHING NY
11354-5516
US

IV. Provider business mailing address

13654 39TH AVE
FLUSHING NY
11354-5516
US

V. Phone/Fax

Practice location:
  • Phone: 718-461-5500
  • Fax: 718-461-5501
Mailing address:
  • Phone: 718-461-5500
  • Fax: 718-461-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DAE GON KIM
Title or Position: OWNER
Credential:
Phone: 347-542-9766