MEDICARE: V & K PHARMACY 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	019588	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
2	3390818	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1366510505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	V & K PHARMACY INC

Provider Business Mailing Address
First Line	:	1227 OGDEN AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-3500
Country	:	US
Telephone Number	:	718-293-8777
Fax Number	:	718-992-1211

Provider Business Practice Location Address
First Line	:	1227 OGDEN AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-3500
Country	:	US
Telephone Number	:	718-293-8777
Fax Number	:	718-992-1211

Authorized Official
Title or Position	:	SUPERVISING PHARMACIST
Name	:	MR. SRINIVASA REDDY KOLLI
Credential	:	RPH
Telephone Number	:	718-293-8777

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	09/23/2009

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Directions to “V & K PHARMACY INC ” Practice Location

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