Healthcare Provider Details

I. General information

NPI: 1477849669
Provider Name (Legal Business Name): MNS PHARMACY CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2011
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 AUDUBON AVENUE
NEW YORK NY
10032
US

IV. Provider business mailing address

29 AUDUBON AVENUE
NEW YORK NY
10032
US

V. Phone/Fax

Practice location:
  • Phone: 646-559-1515
  • Fax: 646-559-1539
Mailing address:
  • Phone: 646-559-1515
  • Fax: 646-559-1539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number17030741
License Number StateNY

VIII. Authorized Official

Name: MR. LEV RAKHMINOV
Title or Position: PRESIDENT
Credential:
Phone: 646-559-1515