Provider Demographics
NPI:1114691656
Name:PREVAIL PHARMACY, INC
Entity Type:Organization
Organization Name:PREVAIL PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VLAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AKILOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-409-3891
Mailing Address - Street 1:850 AMSTERDAM AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5170
Mailing Address - Country:US
Mailing Address - Phone:917-409-3891
Mailing Address - Fax:917-409-3893
Practice Address - Street 1:850 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5170
Practice Address - Country:US
Practice Address - Phone:917-409-3891
Practice Address - Fax:917-409-3893
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREVAIL PHARMACY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy