Active NPI
Healthsource Pharmacy IV, LLC
- Community/Retail Pharmacy
- New York, NY
National Provider Identifier
1053841312
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 035496
- Legal business name
- HEALTHSOURCE PHARMACY IV, LLC
- Doing business as
- HealthSource Pharmacy
- Practice address
- 750 Columbus Ave
New York, NY 10025-6464 - Phone
- (212) 932-0200
- Fax
- (212) 932-0202
- NPI assigned
- Jun 19, 2017
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Boris Niyazov
- Title
- Member
- Phone
- (917) 482-1154
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 035496 | NY | Primary |
| Compounding Pharmacy | 3336C0004X | |||
| Specialty Pharmacy | 3336S0011X |
Addresses
Primary practice location
750 Columbus Ave
New York, NY 10025-6464
Mailing address
750 Columbus Avenue
New York, NY 10025
Phone (212) 932-0200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2169943 | Other | PK |
Other names 1
- HealthSource Pharmacy
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497830400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1497830400000",
"number": "1053841312",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "750 COLUMBUS AVENUE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10025",
"telephone_number": "212-932-0200",
"fax_number": "212-932-0202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "750 COLUMBUS AVE",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100256464",
"telephone_number": "212-932-0200",
"fax_number": "212-932-0202"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HEALTHSOURCE PHARMACY IV, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2017-06-19",
"last_updated": "2017-06-19",
"status": "A",
"authorized_official_last_name": "NIYAZOV",
"authorized_official_first_name": "BORIS",
"authorized_official_title_or_position": "MEMBER",
"authorized_official_telephone_number": "917-482-1154"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "NY",
"license": "035496",
"primary": true
},
{
"code": "3336C0004X",
"taxonomy_group": "",
"desc": "Pharmacy, Compounding Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336S0011X",
"taxonomy_group": "",
"desc": "Pharmacy, Specialty Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2169943",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "HealthSource Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.