MEDICARE: 8TH AVENUE DRUGS & SURGICALS

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	183500000X	Pharmacist	022652	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	:	1326173774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	8TH AVENUE DRUGS & SURGICALS

Provider Business Mailing Address
First Line	:	4821 8TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2213
Country	:	US
Telephone Number	:	718-437-2800
Fax Number	:	718-437-3562

Provider Business Practice Location Address
First Line	:	4821 8TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2213
Country	:	US
Telephone Number	:	718-437-2800
Fax Number	:	718-437-3562

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. KEVIN P JIM
Credential	:	RPH
Telephone Number	:	718-437-2800

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	04/26/2010

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