Organization Active NPI

Vital Med LLC.

  • Community/Retail Pharmacy
  • Flushing, NY
National Provider Identifier
1790163095
Registry record updated Nov 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
VITAL MED LLC.
Practice address
6942 Main St
Flushing, NY 11367-1723
Phone
(718) 544-0700
Fax
(718) 544-0703
NPI assigned
May 7, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2025

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

Authorized official

Name
David Khanimov
Title
President
Phone
(718) 544-0700

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Primary
Specialty Pharmacy 3336S0011X

Addresses

Primary practice location

6942 Main St
Flushing, NY 11367-1723

Mailing address

6942 Main St
Flushing, NY 11367-1723
Phone (718) 544-0700

Other identifiers 1

IdentifierTypeStateIssuer
05013718MedicaidNY

Other names 1

  • VITAL MED 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
O20180125003070 NY DME Supplier - Pharmacy 2961761630 Practice locations: Flushing, NY
O20250729004598 NY Part B Supplier - Mass Immunization (Roster Biller Only) 2961761630 Practice locations: Flushing, NY

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Vital Med LLC6942 Main St, Flushing, NY 11367-1723(718) 544-0700 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Does not accept assignmentParticipating since Oct 31, 2017

National Provider Directory

National Provider Directory

Locations

6942 Main St
Flushing, NY 11367
Phone (718) 544-0700

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": "1430956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763078400000",
    "number": "1790163095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6942 MAIN ST",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113671723",
            "telephone_number": "718-544-0700",
            "fax_number": "718-544-0703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6942 MAIN ST",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113671723",
            "telephone_number": "718-544-0700",
            "fax_number": "718-544-0703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITAL MED LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-07",
        "last_updated": "2025-11-14",
        "certification_date": "2025-11-14",
        "status": "A",
        "authorized_official_last_name": "KHANIMOV",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-544-0700"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05013718",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VITAL MED PHARMACY",
            "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 Nov 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.