Healthcare Provider Details

I. General information

NPI: 1740367564
Provider Name (Legal Business Name): NEW LONDON PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 W 23RD ST
NEW YORK NY
10011-2320
US

IV. Provider business mailing address

241 W 23RD ST
NEW YORK NY
10011-2320
US

V. Phone/Fax

Practice location:
  • Phone: 212-243-4987
  • Fax: 212-243-7110
Mailing address:
  • Phone: 212-243-4987
  • Fax: 212-243-7110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8530
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number8530
License Number StateNY

VIII. Authorized Official

Name: AVGERINI MOUZAKITIS-FAZIO
Title or Position: SUPERVISING PHARMACIST AND OWNER
Credential:
Phone: 212-243-4987