MEDICARE: GNL PHARMACY

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	022434	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	3369471	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER
2	3369471	OTHER	OTHER ID NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083707418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GNL PHARMACY

Provider Business Mailing Address
First Line	:	8610 BAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8610 BAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4102
Country	:	US
Telephone Number	:	718-449-6092
Fax Number	:	718-373-6537

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LEONID KUPERSCHMIDT
Credential	:	RPH
Telephone Number	:	917-364-5462

Provider Enumeration Date	:	09/30/2006
Last Update Date	:	12/21/2007

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Directions to “GNL PHARMACY ” Practice Location

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