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General NPI Number Information
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NPI Number | 1770280927
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Entity Type | Organization
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Legal Business Name | VILLAGE SQUARE RX CORP.
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Dates
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Enumeration Date | 02/08/2023
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Last Update Date | 02/08/2023
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Provider Practice Location Address
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Address Line | 100 VILLAGE SQ STE 130
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City | GLEN COVE
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State | NY
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Zip | 11542-2669
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Country | US
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Telephone | 516-201-2820
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Fax | 516-201-0819
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Provider Business Mailing Address
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Address Line | 100 VILLAGE SQ STE 130
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City | GLEN COVE
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State | NY
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Zip | 11542-2669
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Country | US
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Telephone | 516-201-2820
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Fax | 516-201-0819
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Authorized Official
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Title or Position | PRESIDENT
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Name | YURY ARABOV
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Credential |
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Telephone | 516-201-2820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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