Peach Tree Pharmacy Inc

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

PEACH TREE PHARMACY INC

Practice address

2492 Adam Clayton Powell Jr Blvd
New York, NY 10030-1340

Phone

(646) 755-8262

Fax

(646) 755-8263

NPI assigned

Dec 22, 2022

Organization subpart

No

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

Authorized official

Name

Alexander Lisyansky

Title

Owner

Phone

(908) 320-1027

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

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

{
    "created_epoch": "1671667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671667200000",
    "number": "1366154288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2492 ADAM CLAYTON POWELL JR BLVD",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100301340",
            "telephone_number": "646-755-8262",
            "fax_number": "646-755-8263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2492 ADAM CLAYTON POWELL JR BLVD",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100301340",
            "telephone_number": "646-755-8262",
            "fax_number": "646-755-8263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACH TREE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-22",
        "last_updated": "2022-12-22",
        "certification_date": "2022-12-22",
        "status": "A",
        "authorized_official_last_name": "LISYANSKY",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "908-320-1027"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS BOARD OF PHARMACY",
            "identifier": "039982",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pharmacy in New York, NY
• Providers in New York, NY by specialty
• Pharmacy in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.