Provider Demographics
NPI:1467806398
Name:YOUR CHOICE PHARMACY INC
Entity Type:Organization
Organization Name:YOUR CHOICE PHARMACY INC
Other - Org Name:FIRST CHOICE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAYMARDANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-710-0699
Mailing Address - Street 1:245 E 124TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-2093
Mailing Address - Country:US
Mailing Address - Phone:212-348-6700
Mailing Address - Fax:212-348-6703
Practice Address - Street 1:245 E 124TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-2093
Practice Address - Country:US
Practice Address - Phone:212-348-6700
Practice Address - Fax:212-348-6703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034629333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159431OtherPK