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63rd Drive Pharmacy Corp

Community/Retail Pharmacy in Rego Park, NY · enumerated 2006 · authorized official Simon Ilizarov, President.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1023116050

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Registry record

Entity type Organization (Type 2)
Legal business name 63rd Drive Pharmacy Corp
Other name <Unavail>
Practice address 9305 63rd Dr, Rego Park, NY, 11374
Phone (718) 459-3370
Fax (718) 459-2074
Enumeration date Sep 21, 2006
Last updated in NPPES Sep 11, 2025

Taxonomy & classification

333600000X Pharmacy Suppliers · License 024647 (NY) Secondary
3336C0003X Community/Retail Pharmacy Suppliers Primary

Authorized official

Name Simon Ilizarov
Title President
Phone (718) 459-3370

Other identifiers

Identifier Type State Issuer
3312511 Other - OTHER ID NUMBER-COMMERCIAL NUMBER
02053872 Medicaid NY -

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

Where is 63rd Drive Pharmacy Corp located?
The practice location on file with NPPES is in Rego Park, NY.
How current is this record?
Data comes from the CMS NPPES public dissemination file; this record was last updated in NPPES on 2025-09-11. Verify at npiregistry.cms.hhs.gov.

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2025-09-11.