Healthcare Provider Details

I. General information

NPI: 1891659744
Provider Name (Legal Business Name): JERICHO RX PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 JERICHO TPKE
NEW HYDE PARK NY
11040-4712
US

IV. Provider business mailing address

1519 JERICHO TPKE
NEW HYDE PARK NY
11040-4712
US

V. Phone/Fax

Practice location:
  • Phone: 516-813-2500
  • Fax: 516-813-2800
Mailing address:
  • Phone: 516-813-2500
  • Fax: 516-813-2800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BELLA USHYAROV
Title or Position: PRESIDENT
Credential:
Phone: 516-813-2500