Healthcare Provider Details

I. General information

NPI: 1164332425
Provider Name (Legal Business Name): DIRECT PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 SUNRISE HWY
LYNBROOK NY
11563-3008
US

IV. Provider business mailing address

203 SUNRISE HWY
LYNBROOK NY
11563-3008
US

V. Phone/Fax

Practice location:
  • Phone: 516-333-3331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ARTHUR MAVASHEV
Title or Position: PRESIDENT
Credential:
Phone: 516-333-3331