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General NPI Number Information
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NPI Number | 1346017332
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Entity Type | Organization
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Legal Business Name | PHYSIO PHARMACY INC
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Dates
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Enumeration Date | 12/08/2023
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 488A E JERICHO TPKE
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City | HUNTINGTON STATION
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State | NY
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Zip | 11746-7312
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Country | US
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Telephone | 631-424-0125
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Fax | 631-385-1582
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Provider Business Mailing Address
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Address Line | 488A E JERICHO TPKE
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City | HUNTINGTON STATION
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State | NY
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Zip | 11746-7312
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Country | US
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Telephone | 631-424-0125
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Fax | 631-385-1582
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Authorized Official
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Title or Position | OWNER
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Name | ILYA SHOLOMOV
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Credential |
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Telephone | 631-424-0125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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