MEDICARE: ABIGAILS RX BOUTIQUE 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
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1205675782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABIGAILS RX BOUTIQUE INC.

Provider Business Mailing Address
First Line	:	3121 OCEAN AVENUE UNIT 5
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3405
Country	:	US
Telephone Number	:	718-676-2036
Fax Number	:	718-676-2037

Provider Business Practice Location Address
First Line	:	3121 OCEAN AVENUE UNIT 5
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3405
Country	:	US
Telephone Number	:	718-676-2036
Fax Number	:	718-332-5173

Authorized Official
Title or Position	:	OWNER
Name	:	ARTUR NATANOV
Credential	:
Telephone Number	:	718-676-2036

Provider Enumeration Date	:	05/23/2024
Last Update Date	:	05/01/2025

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