MEDICARE: KINGS BAY CHEMISTS 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	017076	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2060986	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306940366
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGS BAY CHEMISTS INC

Provider Business Mailing Address
First Line	:	3610 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5203
Country	:	US
Telephone Number	:	718-891-3447
Fax Number	:	718-891-9378

Provider Business Practice Location Address
First Line	:	3610 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5203
Country	:	US
Telephone Number	:	718-891-3447
Fax Number	:	718-891-9378

Authorized Official
Title or Position	:	PRES
Name	:	LARRY BIRNBAUM
Credential	:
Telephone Number	:	718-891-9300

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	11/22/2016

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