Provider Demographics
NPI:1619312279
Name:SOS PHARMACY INC
Entity Type:Organization
Organization Name:SOS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHUSHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEMENOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-933-4000
Mailing Address - Street 1:1201 AVENUE Z
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4301
Mailing Address - Country:US
Mailing Address - Phone:917-933-4000
Mailing Address - Fax:917-933-4004
Practice Address - Street 1:1201 AVENUE Z
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4301
Practice Address - Country:US
Practice Address - Phone:917-933-4000
Practice Address - Fax:917-933-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03633823Medicaid
NY032055OtherNY STATE LICENSE
NY5808211OtherNCPDP
NY6979960001OtherMEDICARE NSC
NY6979960001Medicare NSC