Medisource Pharmacy

LBN: Medisource Pharmacy Llc
Medisource Pharmacy is an health care organization with primary practice located at 720 Old Country Rd , Plainview NY 11803-4929. The organization recently has only one registered license in Suppliers / Community/Retail Pharmacy, which is considered as the primary health care specialty. Medisource Pharmacy Llc can be contacted via phone (516) 605-0080, or through Khantses, Dmitriy via phone (917) 885-9883.

Contact Information

Primary practice address
720 Old Country Rd Plainview NY 11803-4929
Phone: (516) 605-0080
Fax: (516) 605-0077
Website:
Map and Directions
Authorized official contact:
Name: Khantses, Dmitriy
Phone: (917) 885-9883

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Community/Retail Pharmacy 3336C0003X 028939 New York

Profile Details

NPI number 1215197991
LBN Legal business name Medisource Pharmacy Llc
DBA Doing business as Medisource Pharmacy
Authorized official Khantses, Dmitriy
Entity Organization
Organization subpart 1 No
Enumeration date Jun 16th, 2008
Last updated Feb 8th, 2021 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215197991 NPPES
New York MEDICAID 3016644
New York Other 2070643

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