=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477849669
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MNS PHARMACY CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2011
-----------------------------------------------------
Last Update Date | 01/31/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29 AUDUBON AVENUE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-559-1515
-----------------------------------------------------
Fax | 646-559-1539
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29 AUDUBON AVENUE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-559-1515
-----------------------------------------------------
Fax | 646-559-1539
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. LEV RAKHMINOV
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 646-559-1515
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 17030741
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------