Provider Demographics
NPI:1174493829
Name:ASTORIA EXPRESS PHARMACY INC
Entity type:Organization
Organization Name:ASTORIA EXPRESS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-533-7562
Mailing Address - Street 1:2108 31ST ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2602
Mailing Address - Country:US
Mailing Address - Phone:718-255-1085
Mailing Address - Fax:718-255-1149
Practice Address - Street 1:2108 31ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2602
Practice Address - Country:US
Practice Address - Phone:718-255-1085
Practice Address - Fax:718-255-1149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-07
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy