Healthcare Provider Details

I. General information

NPI: 1427312214
Provider Name (Legal Business Name): HEALTH CARE PHARMACY OF NY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6061 MYRTLE AVE
RIDGEWOOD NY
11385-5908
US

IV. Provider business mailing address

6061 MYRTLE AVE
RIDGEWOOD NY
11385-5908
US

V. Phone/Fax

Practice location:
  • Phone: 718-417-4154
  • Fax: 718-417-4291
Mailing address:
  • Phone: 718-417-4154
  • Fax: 718-417-4291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number031368
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number031368
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number031368
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number031368
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number031368
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number031368
License Number StateNY

VIII. Authorized Official

Name: MR. ALBERT MUSHIYEV
Title or Position: CEO
Credential:
Phone: 718-417-4154