MEDICARE: AL SAFA AL MARWAH 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	033373	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2150284	OTHER		PK

General Provider Information

NPI Number	:	1245621150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AL SAFA AL MARWAH INC

Provider Business Mailing Address
First Line	:	3138 FULTON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-1916
Country	:	US
Telephone Number	:	917-856-9867
Fax Number	:	718-827-1001

Provider Business Practice Location Address
First Line	:	3138 FULTON ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-1916
Country	:	US
Telephone Number	:	718-827-1000
Fax Number	:	718-827-1001

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MUHAMMAD SADIQ
Credential	:
Telephone Number	:	718-827-1000

Provider Enumeration Date	:	02/13/2015
Last Update Date	:	09/10/2015

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