NPIMap

Organization Active NPI

Medi-Space Pharma Inc

  • Pharmacy
  • Flushing, NY
National Provider Identifier
1003108663
Registry record updated Jun 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
030843 Issued in NY
Legal business name
MEDI-SPACE PHARMA INC
Practice address
4139 Main St
Flushing, NY 11355-3132
Phone
(718) 961-3373
Fax
(718) 961-3311
NPI assigned
May 13, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Hilton CheungNPI 1871815407
Title
President
Phone
(718) 961-3373

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 030843 NY Primary

Addresses

Primary practice location

4139 Main St
Flushing, NY 11355-3132

Mailing address

4139 Main St
Flushing, NY 11355-3132
Phone (718) 961-3373

Other identifiers 3

IdentifierTypeStateIssuer
1003108663MedicaidNY
5803918OtherNCPDP PROVIDER IDENTIFICATION NUMBER
3338492MedicaidNY

Other names 1

  • MEDI-SPACE DRUGS Doing business as

National Provider Directory

National Provider Directory

Locations

4139 Main St
Flushing, NY 11355
Phone (718) 961-3373

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1305244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465171200000",
    "number": "1003108663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4139 MAIN ST",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113553132",
            "telephone_number": "718-961-3373",
            "fax_number": "718-961-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4139 MAIN ST",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113553132",
            "telephone_number": "718-961-3373",
            "fax_number": "718-961-3311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDI-SPACE PHARMA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-13",
        "last_updated": "2016-06-06",
        "status": "A",
        "authorized_official_last_name": "CHEUNG",
        "authorized_official_first_name": "HILTON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-961-3373"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "030843",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003108663",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5803918",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3338492",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDI-SPACE DRUGS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Flushing, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.