MEDICARE: GRUM CORPORATION

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	:	1124763982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRUM CORPORATION

Provider Business Mailing Address
First Line	:	4519 7TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-1495
Country	:	US
Telephone Number	:	718-576-3476
Fax Number	:	718-576-3459

Provider Business Practice Location Address
First Line	:	4519 7TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-1495
Country	:	US
Telephone Number	:	718-576-3476
Fax Number	:	718-576-3459

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MUHAMMAD HASNAIN
Credential	:
Telephone Number	:	718-576-3476

Provider Enumeration Date	:	05/04/2022
Last Update Date	:	09/20/2024

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