=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265212112
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HY PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2023
-----------------------------------------------------
Last Update Date | 10/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13318 41ST RD # 1F
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11355-5867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-300-7800
-----------------------------------------------------
Fax | 929-300-7600
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13318 41ST RD # 1F
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11355-5867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-300-7800
-----------------------------------------------------
Fax | 929-300-7600
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | LINNA LIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 929-300-7800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------