Provider Demographics
NPI:1013336700
Name:NEWMOONPHARMACY INC
Entity Type:Organization
Organization Name:NEWMOONPHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSNAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER
Authorized Official - Phone:718-738-0302
Mailing Address - Street 1:10914 LIBERTY AVE
Mailing Address - Street 2:109-14 LIBERTY AVE
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-1704
Mailing Address - Country:US
Mailing Address - Phone:718-738-0302
Mailing Address - Fax:718-738-0303
Practice Address - Street 1:109-14 LIBERTY AVENUE
Practice Address - Street 2:109-14 LIBRERTY AVENUE
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419
Practice Address - Country:US
Practice Address - Phone:718-738-0302
Practice Address - Fax:718-738-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17032657305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service