MEDICARE: MERGEWELL 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	333600000X	Pharmacy		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PENDING	OTHER	NY	PHARMACY

General Provider Information

NPI Number	:	1154702942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERGEWELL RX INC

Provider Business Mailing Address
First Line	:	759 WASHINGTON AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-4504
Country	:	US
Telephone Number	:	718-638-3800
Fax Number	:	718-638-0239

Provider Business Practice Location Address
First Line	:	759 WASHINGTON AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-4504
Country	:	US
Telephone Number	:	718-638-3800
Fax Number	:	718-638-0239

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	RASIK PATEL
Credential	:	RPH, PHARM D
Telephone Number	:	718-638-3800

Provider Enumeration Date	:	06/17/2015
Last Update Date	:	04/25/2017

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Directions to “MERGEWELL RX INC ” Practice Location

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