Provider Demographics
NPI:1447069331
Name:HEALTH SOURCE PLUS PHARMACY, LLC.
Entity type:Organization
Organization Name:HEALTH SOURCE PLUS PHARMACY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KALONTAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:718-849-6700
Mailing Address - Street 1:11807 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2020
Mailing Address - Country:US
Mailing Address - Phone:718-849-6700
Mailing Address - Fax:
Practice Address - Street 1:11807 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-2020
Practice Address - Country:US
Practice Address - Phone:718-849-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH SOURCE PLUS PHARMACY, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy