MEDICARE: CHARMAR 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	3336C0003X	Community/Retail Pharmacy	018707	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	:	1225043623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARMAR INC

Provider Business Mailing Address
First Line	:	781 LYDIG AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-2144
Country	:	US
Telephone Number	:	718-822-1348
Fax Number	:	718-822-1792

Provider Business Practice Location Address
First Line	:	781 LYDIG AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-2144
Country	:	US
Telephone Number	:	718-822-1348
Fax Number	:	718-822-1792

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GENNADIY MATATOV
Credential	:	R.PH.
Telephone Number	:	718-822-1348

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	08/26/2022

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Directions to “CHARMAR INC ” Practice Location

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