Organization Active NPI

Pharmacy Specs LLC

  • Pharmacy
  • Astoria, NY
National Provider Identifier
1871241240
Registry record updated Mar 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
PHARMACY SPECS LLC
Practice address
4620 Broadway
Astoria, NY 11103-1628
Phone
(718) 255-1047
Fax
(718) 255-1046
NPI assigned
Mar 15, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2022

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

Authorized official

Name
Eduard Borukhov
Title
President
Phone
(718) 255-1047

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X Primary

Addresses

Primary practice location

4620 Broadway
Astoria, NY 11103-1628

Mailing address

4620 Broadway
Astoria, NY 11103-1628
Phone (718) 255-1047

Other identifiers 1

IdentifierTypeStateIssuer
039354OtherNYSTATE BOARD OF PHARMACY

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20221004000973 NY Part B Supplier - Pharmacy 4587040274 Practice locations: Astoria, NY
O20221028000260 NY DME Supplier - Pharmacy 4587040274 Practice locations: Astoria, 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
Pharmacy Specs LLC4620 Broadway, Astoria, NY 11103-1628(718) 255-1047 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Accepts assignmentParticipating since Jun 15, 2022

National Provider Directory

National Provider Directory

Locations

4620 Broadway
Astoria, NY 11103
Phone (718) 255-1047

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": "1647302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647302400000",
    "number": "1871241240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4620 BROADWAY",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111031628",
            "telephone_number": "718-255-1047",
            "fax_number": "718-255-1046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4620 BROADWAY",
            "city": "ASTORIA",
            "state": "NY",
            "postal_code": "111031628",
            "telephone_number": "718-255-1047",
            "fax_number": "718-255-1046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHARMACY SPECS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-15",
        "last_updated": "2022-03-15",
        "certification_date": "2022-03-15",
        "status": "A",
        "authorized_official_last_name": "BORUKHOV",
        "authorized_official_first_name": "EDUARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-255-1047"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE BOARD OF PHARMACY",
            "identifier": "039354",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Astoria, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2022; 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.