Provider Demographics
NPI:1265040240
Name:MERRICK BLVD PHARMACY INC
Entity Type:Organization
Organization Name:MERRICK BLVD PHARMACY INC
Other - Org Name:MERRICK SPECIALTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSHUVAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-561-9686
Mailing Address - Street 1:10950 MERRICK BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-3056
Mailing Address - Country:US
Mailing Address - Phone:347-561-9686
Mailing Address - Fax:
Practice Address - Street 1:10950 MERRICK BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-3056
Practice Address - Country:US
Practice Address - Phone:347-561-9686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERRICK PHARMACY BLVD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-16
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy