MEDICARE: SR AND AG CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063577674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SR AND AG CORP

Provider Business Mailing Address
First Line	:	250 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-1205
Country	:	US
Telephone Number	:	718-946-6899
Fax Number	:	718-946-2743

Provider Business Practice Location Address
First Line	:	250 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-1205
Country	:	US
Telephone Number	:	718-946-6899
Fax Number	:	718-946-2743

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SVETLANA GOLDENBERG
Credential	:	RPH
Telephone Number	:	718-946-6899

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	02/21/2019

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Directions to “SR AND AG CORP ” Practice Location

Language	Start Address	Practice Location

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