=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730973413
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH STATION PHARMACY CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2025
-----------------------------------------------------
Last Update Date | 04/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 755 FRANKLIN AVE
-----------------------------------------------------
City | FRANKLIN SQUARE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11010-1030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-341-0698
-----------------------------------------------------
Fax | 516-341-0699
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 755 FRANKLIN AVE
-----------------------------------------------------
City | FRANKLIN SQUARE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11010-1030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-341-0698
-----------------------------------------------------
Fax | 516-341-0699
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RAFAEL KHAIMOV
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-341-0698
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------