MEDICARE: LOGOS PHARMACY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1962101196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOGOS PHARMACY, LLC

Provider Business Mailing Address
First Line	:	12 NEW DORP LN
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-2323
Country	:	US
Telephone Number	:	917-456-1066
Fax Number	:	917-456-1067

Provider Business Practice Location Address
First Line	:	12 NEW DORP LN
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-2323
Country	:	US
Telephone Number	:	917-456-1066
Fax Number	:	917-456-1067

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	PETER MESHREKY
Credential	:
Telephone Number	:	917-456-1066

Provider Enumeration Date	:	02/27/2023
Last Update Date	:	09/26/2023

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