Provider Demographics
NPI:1457782013
Name:PYAK FAMILY LLC
Entity Type:Organization
Organization Name:PYAK FAMILY LLC
Other - Org Name:YOUR CHOICE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VYACHESLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:PYAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-606-8965
Mailing Address - Street 1:63106 WOODHAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4841
Mailing Address - Country:US
Mailing Address - Phone:718-606-8965
Mailing Address - Fax:718-606-8948
Practice Address - Street 1:63106 WOODHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4841
Practice Address - Country:US
Practice Address - Phone:718-606-8965
Practice Address - Fax:718-606-8948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0324123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03885343Medicaid
2143736OtherPK