Provider Demographics
NPI:1518483940
Name:NOVA PHARMACY QUEENS, L.L.C.
Entity type:Organization
Organization Name:NOVA PHARMACY QUEENS, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MONDOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-255-2311
Mailing Address - Street 1:10401 NORTHERN BLVD FL 1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11368-1134
Mailing Address - Country:US
Mailing Address - Phone:646-809-9595
Mailing Address - Fax:929-895-9592
Practice Address - Street 1:10401 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-1134
Practice Address - Country:US
Practice Address - Phone:718-450-9595
Practice Address - Fax:718-450-9797
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIVA PHARMACY & WELLNESS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-17
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy