MEDICARE: 21 AVE PHARMACY & MEDICAL SUPPLY 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy	028463	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215127576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	21 AVE PHARMACY & MEDICAL SUPPLY INC.

Provider Business Mailing Address
First Line	:	8511 21ST AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3207
Country	:	US
Telephone Number	:	718-449-4949
Fax Number	:	718-449-4893

Provider Business Practice Location Address
First Line	:	8511 21ST AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3207
Country	:	US
Telephone Number	:	718-449-4949
Fax Number	:	718-449-4893

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AKRAM TUYLIEV
Credential	:
Telephone Number	:	718-449-4949

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	06/16/2026

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