NPIMap

Organization Active NPI

Main Source Pharmacy Inc

  • Community/Retail Pharmacy
  • Huntington, NY
National Provider Identifier
1689179178
Registry record updated Sep 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
036497 Issued in NY
Legal business name
MAIN SOURCE PHARMACY INC
Practice address
347 Main St
Huntington, NY 11743-6914
Phone
(631) 760-1114
Fax
(631) 760-1035
NPI assigned
Mar 27, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2018

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

Authorized official

Name
Svetlana NiyazovaNPI 1558602193
Title
Owner,RPH,Ao
Phone
(631) 760-1114

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 036497 NY Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

347 Main St
Huntington, NY 11743-6914

Mailing address

347B Main St
Huntington, NY 11743-6914
Phone (631) 760-1114

Other identifiers 1

IdentifierTypeStateIssuer
2176773OtherPK

Other names 1

  • Main Source Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20181019000185 NY DME Supplier - Pharmacy 4688920226 Practice locations: Huntington, NY
O20250326001910 NY Part B Supplier - Mass Immunization (Roster Biller Only) 4688920226 Practice locations: Huntington, NY

National Provider Directory

National Provider Directory
Tax ID family
Main Source Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

347 Main St
Huntington, NY 11743
Phone (631) 427-6060

Practitioners & affiliated clinicians

Practitioners 8

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": "1522108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537142400000",
    "number": "1689179178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "347B MAIN ST",
            "city": "HUNTINGTON",
            "state": "NY",
            "postal_code": "117436914",
            "telephone_number": "631-760-1114",
            "fax_number": "631-760-1035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "347 MAIN ST",
            "city": "HUNTINGTON",
            "state": "NY",
            "postal_code": "117436914",
            "telephone_number": "631-760-1114",
            "fax_number": "631-760-1035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN SOURCE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-27",
        "last_updated": "2018-09-17",
        "status": "A",
        "authorized_official_last_name": "NIYAZOVA",
        "authorized_official_first_name": "SVETLANA",
        "authorized_official_title_or_position": "OWNER,RPH,AO",
        "authorized_official_telephone_number": "631-760-1114"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NY",
            "license": "036497",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2176773",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Source Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Huntington, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2018; 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.