Healthcare Provider Details

I. General information

NPI: 1508357989
Provider Name (Legal Business Name): HCOR SPECIALTY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11659 QUEENS BLVD
FOREST HILLS NY
11375-6533
US

IV. Provider business mailing address

11659 QUEENS BLVD
FOREST HILLS NY
11375-6533
US

V. Phone/Fax

Practice location:
  • Phone: 888-425-4267
  • Fax: 347-565-0326
Mailing address:
  • Phone: 888-425-4267
  • Fax: 347-565-0326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number036542
License Number StateNY

VIII. Authorized Official

Name: STANISLAV ZAVULUNOV
Title or Position: MANAGING MEMBER
Credential:
Phone: 347-389-5826