Provider Demographics
NPI:1235935719
Name:119TH ST PHARMACY LLC
Entity type:Organization
Organization Name:119TH ST PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIRSAID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHADIEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-348-0044
Mailing Address - Street 1:181 E 119TH ST # 10035
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-4069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:181 E 119TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-4069
Practice Address - Country:US
Practice Address - Phone:929-348-0044
Practice Address - Fax:347-330-7662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-24
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy