Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Healthsource Pharmacy IV, LLC

Organization Pharmacy · NPI 1053841312

Healthsource Pharmacy IV, LLC is a Pharmacy in New York, New York. Licensed in New York. Registered with an NPI since 2017.

Licensed in
NY
In the registry since
2017
Specialties on file
4
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

750 Columbus Ave
New York, NY 10025-6464
Phone: (212) 932-0200
Fax: (212) 932-0202
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Community/Retail Pharmacy (primary) Taxonomy 3336C0003X · Licence 035496 (NY)
Pharmacy Taxonomy 333600000X
Compounding Pharmacy Taxonomy 3336C0004X
Specialty Pharmacy Taxonomy 3336S0011X

Record details

NPI number1053841312
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Boris Niyazov — Member · (917) 482-1154
Other names Healthsource Pharmacy
NPI enumeratedJune 19, 2017
Last updated in NPPESJune 19, 2017
Mailing address750 Columbus Avenue, New York, NY 10025

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