Provider Demographics
NPI:1700301744
Name:MOUNT SINAI PHARMACY INC
Entity Type:Organization
Organization Name:MOUNT SINAI PHARMACY INC
Other - Org Name:MOUNT SINAI PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRIGORI
Authorized Official - Middle Name:
Authorized Official - Last Name:ILYAEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-879-8070
Mailing Address - Street 1:720A E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5002
Mailing Address - Country:US
Mailing Address - Phone:347-879-8070
Mailing Address - Fax:347-879-8072
Practice Address - Street 1:720A E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5002
Practice Address - Country:US
Practice Address - Phone:347-879-8070
Practice Address - Fax:347-879-8072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy