Healthcare Provider Details

I. General information

NPI: 1508776220
Provider Name (Legal Business Name): LEVERAGE RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11345 FARMERS BLVD
SAINT ALBANS NY
11412-2425
US

IV. Provider business mailing address

11345 FARMERS BLVD
SAINT ALBANS NY
11412-2425
US

V. Phone/Fax

Practice location:
  • Phone: 917-780-9919
  • Fax: 347-426-4584
Mailing address:
  • Phone: 917-780-9919
  • Fax: 347-426-4584

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: IRINA YUSUPOV
Title or Position: PRESIDENT
Credential:
Phone: 917-780-9919