Healthcare Provider Details

I. General information

NPI: 1578290433
Provider Name (Legal Business Name): MIDLAND PHARMACY YONKERS CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

861 MIDLAND AVE
YONKERS NY
10704-1024
US

IV. Provider business mailing address

861 MIDLAND AVE
YONKERS NY
10704-1024
US

V. Phone/Fax

Practice location:
  • Phone: 914-968-0349
  • Fax: 914-968-0357
Mailing address:
  • Phone: 914-968-0349
  • Fax: 914-968-0357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BINYAMIN DEZORAIEV
Title or Position: OWNER
Credential:
Phone: 914-968-0349