Provider Demographics
NPI:1316761679
Name:VALUE MART PHARMACY INC.
Entity type:Organization
Organization Name:VALUE MART PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ILINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAKHMUROVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-971-6643
Mailing Address - Street 1:19111 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2527
Mailing Address - Country:US
Mailing Address - Phone:718-971-6643
Mailing Address - Fax:718-691-4121
Practice Address - Street 1:19111 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2527
Practice Address - Country:US
Practice Address - Phone:718-971-6643
Practice Address - Fax:718-691-4121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy