| NPI | 1962792176 |
|---|---|
| Doing Business As | HEALTHSOURCE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | BORIS NIYAZOV President 212-310-0111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: NY 030612) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2011-04-10 |
| Last Update Date | 2017-02-16 |