Provider Demographics
NPI:1235835547
Name:QUALITY LIFE PHARMACY CORP
Entity Type:Organization
Organization Name:QUALITY LIFE PHARMACY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YAKOV
Authorized Official - Middle Name:
Authorized Official - Last Name:KATANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-544-7182
Mailing Address - Street 1:7168 YELLOWSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4115
Mailing Address - Country:US
Mailing Address - Phone:718-544-7182
Mailing Address - Fax:718-544-7199
Practice Address - Street 1:7168 YELLOWSTONE BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4115
Practice Address - Country:US
Practice Address - Phone:718-544-7182
Practice Address - Fax:718-544-7199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04242926Medicaid