MEDICARE: SHALOM'S DIABETES HEALTH AND WELLNESS CENTER

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	30383	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	:	1275888463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHALOM'S DIABETES HEALTH AND WELLNESS CENTER

Provider Business Mailing Address
First Line	:	1490 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-4714
Country	:	US
Telephone Number	:	718-253-4900
Fax Number	:	718-253-4905

Provider Business Practice Location Address
First Line	:	1490 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-4714
Country	:	US
Telephone Number	:	718-253-4900
Fax Number	:	718-253-4905

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. SHALOM RAKHMINOV
Credential	:
Telephone Number	:	718-253-4900

Provider Enumeration Date	:	07/13/2012
Last Update Date	:	08/06/2025

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