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NPI Code Detail

MEDICARE: SILVER OAK PHARMACY INC

MEDICARE: SILVER OAK PHARMACY 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
13336C0003XCommunity/Retail Pharmacy027964NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1027964OTHERNYPHARMACY REGISTRATION NUM

General Provider Information

NPI Number : 1154503746
Entity Type Code : Organization
Provider Name (Legal Business Name) : SILVER OAK PHARMACY INC
Provider Business Mailing Address
First Line : 5105 CHURCH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-3511
Country : US
Telephone Number : 718-240-9924
Fax Number : 718-240-9211
Provider Business Practice Location Address
First Line : 5105 CHURCH AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11203-3511
Country : US
Telephone Number : 718-240-9924
Fax Number : 718-240-9211
Authorized Official
Title or Position : PRESIDENT
Name : MR. AXAY B JOSHI
Credential : B,SC
Telephone Number : 718-240-9924
Provider Enumeration Date : 12/05/2007
Last Update Date : 01/29/2009

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