Healthcare Provider Details

I. General information

NPI: 1609784875
Provider Name (Legal Business Name): 167 PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 GLEN HEAD RD
GLEN HEAD NY
11545-3400
US

IV. Provider business mailing address

167 GLEN HEAD RD
GLEN HEAD NY
11545-3400
US

V. Phone/Fax

Practice location:
  • Phone: 516-200-5304
  • Fax: 516-669-3437
Mailing address:
  • Phone: 516-200-5304
  • Fax: 516-669-3437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROZA YAKUBOVA
Title or Position: OWNER
Credential:
Phone: 917-605-7527