Medisource Pharmacy LLC
NPI 1215197991ActiveOrganization· Pharmacy, Specialty Pharmacy· Plainview, NY
Pharmacy, Specialty Pharmacy in Plainview, New York, registered in NPPES in June 2008. The authorized official on file is Roza Davidov, Owner. Enrolled in Medicare as dme supplier - pharmacy and part b supplier - mass immunization (roster biller only).
Overview
| NPI | 1215197991 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jun 16, 2008 |
| Last updated in NPPES | Jan 27, 2026 |
| Certified by provider | Jan 27, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Pharmacy, Specialty Pharmacy Primary | 3336S0011X | 028939 | NY |
| Pharmacy, Community/Retail Pharmacy | 3336C0003X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled DME Supplier - Pharmacy (NY); Part B Supplier - Mass Immunization (Roster Biller Only) (NY); Part B Supplier - Pharmacy (NY) |
|---|
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