| NPI | 1053841312 |
|---|---|
| Doing Business As | HEALTHSOURCE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | BORIS NIYAZOV Member 917-482-1154 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: NY 035496) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0004X Pharmacy, Compounding Pharmacy | |
| 3336S0011X Pharmacy, Specialty Pharmacy | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2017-06-19 |