MEDICARE: VANDERVEER RX INC

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

General Provider Information

NPI Number	:	1073494365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANDERVEER RX INC

Provider Business Mailing Address
First Line	:	1913 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-7917
Country	:	US
Telephone Number	:	718-282-2956
Fax Number	:

Provider Business Practice Location Address
First Line	:	1913 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-7917
Country	:	US
Telephone Number	:	718-282-2956
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. AZA KHAN
Credential	:
Telephone Number	:	917-913-1007

Provider Enumeration Date	:	09/11/2025
Last Update Date	:	09/11/2025

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