Provider Demographics
NPI:1790144145
Name:YOZA CORP
Entity Type:Organization
Organization Name:YOZA CORP
Other - Org Name:HEWLETT NEIGHBORHOOD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOSHAYEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-791-2400
Mailing Address - Street 1:6 CEDARHURST AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2142
Mailing Address - Country:US
Mailing Address - Phone:347-342-8222
Mailing Address - Fax:516-791-2401
Practice Address - Street 1:1181 BROADWAY
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-2323
Practice Address - Country:US
Practice Address - Phone:516-791-2400
Practice Address - Fax:516-791-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-13
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034343333600000X
3336C0003X, 3336M0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158234OtherPK
NY7518050001Medicare NSC