MEDICARE: OPTIMUM PHARMACY LLC

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

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	:	1215378419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMUM PHARMACY LLC

Provider Business Mailing Address
First Line	:	3324 THIRD AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-6749
Country	:	US
Telephone Number	:	347-577-1170
Fax Number	:	347-577-1171

Provider Business Practice Location Address
First Line	:	3324 THIRD AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-6749
Country	:	US
Telephone Number	:	347-577-1170
Fax Number	:	347-577-1171

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. AYODEJI ADEGBOYEJO
Credential	:
Telephone Number	:	347-577-1170

Provider Enumeration Date	:	07/16/2013
Last Update Date	:	02/10/2017

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Directions to “OPTIMUM PHARMACY LLC ” Practice Location

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