| NPI | 1174983977 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VYACHESLAV MUSHYAKOV Owner 718-991-3400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: NY 034339) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 333600000X Pharmacy | |
| Enumeration Date | 2016-03-07 |
| Last Update Date | 2016-09-30 |