| NPI | 1215197991 |
|---|---|
| Doing Business As | MEDISOURCE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | ROZA DAVIDOV Owner 516-615-2974 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: NY 028939) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2025-06-27 |